Provider Demographics
NPI:1194959106
Name:PEREIRA, JENNIFER KATHRYN (PHD, LPC, RPT-S,)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:PHD, LPC, RPT-S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 W CORONA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1184
Mailing Address - Country:US
Mailing Address - Phone:352-262-2125
Mailing Address - Fax:
Practice Address - Street 1:1345 E CHANDLER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6280
Practice Address - Country:US
Practice Address - Phone:352-262-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16425101YM0800X
101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health