# SACRED SPACE MARRIAGE THERAPY, PROF. CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831059468
- **Authorized official:** SHANNON RODRIGUEZ LMFT (THERAPIST)
- **Authorized official phone:** (951) 219-3255

## Contact information

- **Practice address:** 31526 RAILROAD CANYON RD STE 5, CANYON LAKE, CA 92587-9443
- **Practice address phone:** (951) 219-3255
- **Mailing address:** 31724 CASINO DR, LAKE ELSINORE, CA 92530-4510
- **Mailing address phone:** (951) 219-3255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 11/15/2025
- **Last updated:** 11/15/2025