Provider Demographics
NPI:1790848208
Name:VERBANSKY, BECKY LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:LYNN
Last Name:VERBANSKY
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 1:16155 SIERRA LAKES PKWY
Mailing Address - Street 2:SUITE 160-602
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1244
Mailing Address - Country:US
Mailing Address - Phone:909-963-6164
Mailing Address - Fax:
Practice Address - Street 1:8350 ARCHIBALD AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3669
Practice Address - Country:US
Practice Address - Phone:909-963-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist