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General NPI Number Information
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NPI Number | 1720952583
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Entity Type | Individual
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Provider Name | JENNIFER GLORIA EVANGELISTA LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 15455 SAN FERNANDO MISSION BLVD STE 300
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City | MISSION HILLS
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State | CA
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Zip | 91345-1353
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Country | US
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Telephone | 818-408-9284
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Fax | 818-847-7830
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Provider Business Mailing Address
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Address Line | 21439 MAYAN DR
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City | CHATSWORTH
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State | CA
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Zip | 91311-1499
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Country | US
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Telephone | 818-282-6312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 136702
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License Number State | CA
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