Provider Demographics
NPI:1700431459
Name:BRAVO, GERSON YESTIN (LMFT, APCC)
Entity type:Individual
Prefix:MR
First Name:GERSON
Middle Name:YESTIN
Last Name:BRAVO
Suffix:
Gender:M
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 BLUEBELL WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6602
Mailing Address - Country:US
Mailing Address - Phone:909-233-0766
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-330-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist