Healthcare Provider Details

I. General information

NPI: 1659298735
Provider Name (Legal Business Name): BRIANNA NICOLE GOMEZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 CLOVIS AVE
CLOVIS CA
93612-1115
US

IV. Provider business mailing address

1295 N WISHON AVE STE 211
FRESNO CA
93728-2350
US

V. Phone/Fax

Practice location:
  • Phone: 559-545-7087
  • Fax: 559-324-6565
Mailing address:
  • Phone: 559-372-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number164229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: