1679425219 NPI number — JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679425219 NPI number — JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JRP COUNSELING LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679425219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 LYRA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92223-2079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-305-3071
Provider Business Mailing Address Fax Number:
951-602-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1091 N PALM CANYON DR STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-305-3071
Provider Business Practice Location Address Fax Number:
951-602-6006
Provider Enumeration Date:
02/13/2026

Additional Information

Authorized Official

Authorized Official Last Name:
RUGALA PERSICONE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
951-255-1754

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com