Provider Demographics
NPI:1568776425
Name:DENNIS, REBECCA LEA (MFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 LASAINE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5429
Mailing Address - Country:US
Mailing Address - Phone:818-379-3377
Mailing Address - Fax:
Practice Address - Street 1:6531 LASAINE AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5429
Practice Address - Country:US
Practice Address - Phone:818-379-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 16240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist