=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720623184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YESSICA AVANCENA, LMFT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2019
-----------------------------------------------------
Last Update Date | 11/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 WESTWIND DR STE 111
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-304-7570
-----------------------------------------------------
Fax | 661-829-7301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11000 BRIMHALL RD STE E
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93312-3022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-304-7570
-----------------------------------------------------
Fax | 661-829-7301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | YESSICA AVANCENA
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 661-304-7570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------