Provider Demographics
NPI:1417079807
Name:NORRIS, REBECCA C (MS, IMFT 47645)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MS, IMFT 47645
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 PLEASANT VALLEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9260
Mailing Address - Country:US
Mailing Address - Phone:530-621-6218
Mailing Address - Fax:530-653-2179
Practice Address - Street 1:344 PLACERVILLE DR STE 17
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3972
Practice Address - Country:US
Practice Address - Phone:530-621-6336
Practice Address - Fax:530-622-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist