Provider Demographics
NPI:1881067262
Name:VIVO, GENE CHRISSY ROSALES (LMFT)
Entity type:Individual
Prefix:
First Name:GENE CHRISSY
Middle Name:ROSALES
Last Name:VIVO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GENE CHRISSY
Other - Middle Name:PEREZ
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:6160 MISSION GORGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3425
Mailing Address - Country:US
Mailing Address - Phone:619-481-3790
Mailing Address - Fax:
Practice Address - Street 1:6160 MISSION GORGE RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3425
Practice Address - Country:US
Practice Address - Phone:619-481-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89845106H00000X
CA110001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist