MEDICARE: SACRED SPACE MARRIAGE THERAPY, PROF. CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1689526311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED SPACE MARRIAGE THERAPY, PROF. CORP

Provider Business Mailing Address
First Line	:	31577 CANYON ESTATES DR STE 225
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0473
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31577 CANYON ESTATES DR STE 225
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0473
Country	:	US
Telephone Number	:	951-219-3255
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	SHANNON RODRIGUEZ
Credential	:	LMFT
Telephone Number	:	951-219-3255

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

Similar Medicare Providers

1316492895 — STARLA AFFATATI MS-CCC, SLP
Practice Location Address:

31577 CANYON ESTATES DR STE 230
LAKE ELSINORE, CA
92532-0473

Practice Phone: 951-226-4314
Practice Fax:

1235696030 — JORDAN PITCHER BRAND DC
Practice Location Address:

31577 CANYON ESTATES DR STE 225
LAKE ELSINORE, CA
92532-0473

Practice Phone: 909-283-0048
Practice Fax: 951-916-4895

1699976662 — DR. CARL H REINIGHAUS DO
Practice Location Address:

135 SOUTH BASS LAKE LANE
IRON MOUNTAIN, MI
49801-0473

Practice Phone: 906-774-5082
Practice Fax:

1619249414 — KRISTIN MARGARET MARTINEZ LMFT #90136
Practice Location Address:

30 VISTA TOSCANA
LAKE ELSINORE, CA
92532-0215

Practice Phone: 951-291-8479
Practice Fax:

1225980865 — ALYSSA MAHEALANI OHARA
Practice Location Address:

34257 KALANCHOE RD
LAKE ELSINORE, CA
92532-2996

Practice Phone: 951-244-7657
Practice Fax:

1811999261 — DR. MOHAMMAD REZA DANESH M.D.
Practice Location Address:

31581 CANYON ESTATES DR
LAKE ELSINORE, CA
92532-0424

Practice Phone: 951-244-3500
Practice Fax: 951-244-3535

Directions to “SACRED SPACE MARRIAGE THERAPY, PROF. CORP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.