Provider Demographics
NPI:1336271972
Name:LOPEZ, SASHA YADYRA (LICENSED MFT)
Entity type:Individual
Prefix:MRS
First Name:SASHA
Middle Name:YADYRA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30732 ROARING RIVER DR
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9641
Mailing Address - Country:US
Mailing Address - Phone:559-668-0679
Mailing Address - Fax:
Practice Address - Street 1:30732 ROARING RIVER DR
Practice Address - Street 2:
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-9641
Practice Address - Country:US
Practice Address - Phone:559-668-0679
Practice Address - Fax:559-234-4683
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125509106H00000X
CAIMF 50609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA125509OtherBBS