Provider Demographics
NPI:1164132189
Name:REBECCA PITTENGER PHD
Entity Type:Organization
Organization Name:REBECCA PITTENGER PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTENGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-931-1629
Mailing Address - Street 1:960 W GRAND AVE STE H
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2121
Mailing Address - Country:US
Mailing Address - Phone:323-739-8444
Mailing Address - Fax:
Practice Address - Street 1:960 W GRAND AVE STE H
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2121
Practice Address - Country:US
Practice Address - Phone:323-739-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty