Provider Demographics
NPI:1285666396
Name:HYATT, REBECCA SUE (LCSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:HYATT
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E. TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-0102
Mailing Address - Country:US
Mailing Address - Phone:760-318-6570
Mailing Address - Fax:760-318-6580
Practice Address - Street 1:1111 E. TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 121
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0102
Practice Address - Country:US
Practice Address - Phone:760-861-2591
Practice Address - Fax:760-770-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS90751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050513OtherMANAGED HEALTH NETWORK
CA072767000OtherMAGELLAN PROVIDER #