Healthcare Provider Details

I. General information

NPI: 1750782140
Provider Name (Legal Business Name): EVELYN ASHLEY RODRIGUEZ M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N FRESNO ST STE 201
FRESNO CA
93710-5280
US

IV. Provider business mailing address

4440 N 1ST ST
FRESNO CA
93726-2304
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8550
  • Fax: 559-248-8555
Mailing address:
  • Phone: 559-229-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: