Provider Demographics
NPI:1639238785
Name:GOMEZ, REBECCA R (LMFT, MS)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 N 1ST ST
Mailing Address - Street 2:129
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0989
Mailing Address - Country:US
Mailing Address - Phone:559-797-1880
Mailing Address - Fax:
Practice Address - Street 1:55 SHAW AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3819
Practice Address - Country:US
Practice Address - Phone:559-797-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist