Organization Active NPI

Sacred Space Marriage Therapy, Prof. Corp

  • Marriage & Family Therapist
  • Canyon Lake, CA
National Provider Identifier
1831059468
Registry record updated Nov 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
SACRED SPACE MARRIAGE THERAPY, PROF. CORP
Practice address
31526 Railroad Canyon Rd Ste 5
Canyon Lake, CA 92587-9443
Phone
(951) 219-3255
NPI assigned
Nov 15, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shannon Rodriguez, LMFTNPI 1750832226
Title
Therapist
Phone
(951) 219-3255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

31526 Railroad Canyon Rd Ste 5
Canyon Lake, CA 92587-9443

Mailing address

31724 Casino Dr
Lake Elsinore, CA 92530-4510
Phone (951) 219-3255

National Provider Directory

National Provider Directory

Locations

31526 Railroad Canyon Rd
Ste 5
Canyon Lake, CA 92587
Phone (951) 219-3255

31724 Casino Dr
Lake Elsinore, CA 92530

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763164800000",
    "number": "1831059468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31724 CASINO DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304510",
            "telephone_number": "951-219-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31526 RAILROAD CANYON RD STE 5",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879443",
            "telephone_number": "951-219-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE MARRIAGE THERAPY, PROF. CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-15",
        "last_updated": "2025-11-15",
        "certification_date": "2025-11-15",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "951-219-3255",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canyon Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.