Provider Demographics
NPI:1659405785
Name:OTTEN, REBECCA ANN (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ANN
Last Name:OTTEN
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 1:55 SHAW AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3819
Mailing Address - Country:US
Mailing Address - Phone:559-549-6066
Mailing Address - Fax:559-272-2202
Practice Address - Street 1:55 SHAW AVE STE 120
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-549-6066
Practice Address - Fax:559-272-2202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45647106H00000X
CA46527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist