MEDICARE: BRENDA YESENIA MORGAN-RIVERA I

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	101YP2500X	Professional Counselor	10630	CA
2	101YP2500X	Professional Counselor	128325	CA
3	106H00000X	Marriage & Family Therapist	128325	CA

General Provider Information

NPI Number	:	1770224776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA YESENIA MORGAN-RIVERA I

Provider Business Mailing Address
First Line	:	131 STONY CIR STE 1200
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4174
Country	:	US
Telephone Number	:	707-509-9373
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 STONY CIR STE 1200
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4174
Country	:	US
Telephone Number	:	707-509-9373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	05/26/2026

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