Healthcare Provider Details

I. General information

NPI: 1013842640
Provider Name (Legal Business Name): BEAUTIFUL EVOLUTION MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 LAVA RIDGE CT STE 180
ROSEVILLE CA
95661-3075
US

IV. Provider business mailing address

3010 LAVA RIDGE CT STE 180
ROSEVILLE CA
95661-3075
US

V. Phone/Fax

Practice location:
  • Phone: 916-415-8421
  • Fax:
Mailing address:
  • Phone: 916-415-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER CLEARWATER
Title or Position: PRESIDENT
Credential: LMFT 161786
Phone: 916-415-8421