Provider Demographics
NPI:1528571692
Name:REBECCA MCGRUE LMFT DBA MIND OVER MOOD THERAPY
Entity Type:Organization
Organization Name:REBECCA MCGRUE LMFT DBA MIND OVER MOOD THERAPY
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:MCGRUE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-862-4984
Mailing Address - Street 1:4372 AUBERGINE WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-3039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3336 BRADSHAW RD STE 215
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2624
Practice Address - Country:US
Practice Address - Phone:916-862-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty