Provider Demographics
NPI:1871538306
Name:CERVANTES, JESUS (PSY D LMFT)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:PSY D LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001A EAST PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-875-9875
Mailing Address - Fax:916-875-0877
Practice Address - Street 1:7001A EAST PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2501
Practice Address - Country:US
Practice Address - Phone:916-875-9875
Practice Address - Fax:916-875-0877
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB31462101Y00000X
CAMFC 48588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor