Provider Demographics
NPI:1972895530
Name:AVANCENA, YESSICA DELAROSA (MFT)
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:DELAROSA
Last Name:AVANCENA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-7163
Mailing Address - Fax:661-868-7172
Practice Address - Street 1:8307 BRIMHALL RD STE 1705
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-4343
Practice Address - Country:US
Practice Address - Phone:661-829-7301
Practice Address - Fax:661-882-9730
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84817106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEINOther37-1897987