Provider Demographics
NPI:1871043505
Name:OCHOA, REBECCA TYRRELL (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:TYRRELL
Last Name:OCHOA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYN
Other - Last Name:TYRRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:960 SARATOGA AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3413
Mailing Address - Country:US
Mailing Address - Phone:408-784-4287
Mailing Address - Fax:
Practice Address - Street 1:960 SARATOGA AVE STE 213
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3413
Practice Address - Country:US
Practice Address - Phone:408-784-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109340106H00000X
CAIMF79328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist