Provider Demographics
NPI:1720952583
Name:EVANGELISTA, JENNIFER GLORIA (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GLORIA
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21439 MAYAN DR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1499
Mailing Address - Country:US
Mailing Address - Phone:818-282-6312
Mailing Address - Fax:
Practice Address - Street 1:15455 SAN FERNANDO MISSION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1353
Practice Address - Country:US
Practice Address - Phone:818-408-9284
Practice Address - Fax:818-847-7830
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty