Provider Demographics
NPI:1043439755
Name:HEISLER, REBECCA (MFT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:HEISLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ROBBY
Other - Last Name:HEISLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3760 CONVOY ST STE 118
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3743
Mailing Address - Country:US
Mailing Address - Phone:619-515-4622
Mailing Address - Fax:
Practice Address - Street 1:3760 CONVOY ST STE 118
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3743
Practice Address - Country:US
Practice Address - Phone:619-515-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 19487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist