Provider Demographics
NPI:1477618460
Name:GARTH-NELSON, REBECCA H (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:H
Last Name:GARTH-NELSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:H
Other - Last Name:GARTH-NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5403 E BELLAIRE WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-7540
Mailing Address - Country:US
Mailing Address - Phone:559-292-5639
Mailing Address - Fax:
Practice Address - Street 1:4411 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:559-453-6304
Practice Address - Fax:559-453-8944
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC40580OtherCA STATE LICENSE