Provider Demographics
NPI:1659562791
Name:PORTEOUS, REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:PORTEOUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-0992
Mailing Address - Country:US
Mailing Address - Phone:707-822-1496
Mailing Address - Fax:707-822-1406
Practice Address - Street 1:3135 BOEING AVE STE A1
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-9373
Practice Address - Country:US
Practice Address - Phone:707-633-6145
Practice Address - Fax:707-633-6128
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS184591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical