Provider Demographics
NPI:1518444876
Name:BEVILLE, REBECCA ANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:BEVILLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 4TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6223
Mailing Address - Country:US
Mailing Address - Phone:619-346-1363
Mailing Address - Fax:
Practice Address - Street 1:2729 4TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6223
Practice Address - Country:US
Practice Address - Phone:619-346-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist