Healthcare Provider Details

I. General information

NPI: 1679173835
Provider Name (Legal Business Name): CRISTINA PALACIOS-GOMEZ AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W. FALLBROOK AVE. STE 105
FRESNO CA
93711-6191
US

IV. Provider business mailing address

410 W. FALLBROOK AVE. STE. 105
FRESNO CA
93711-6191
US

V. Phone/Fax

Practice location:
  • Phone: 559-472-0501
  • Fax:
Mailing address:
  • Phone: 559-472-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: