Provider Demographics
NPI:1932503414
Name:AREVALO, REBECCA (MFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:AREVALO
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 1:305 N HARBOR BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1990
Mailing Address - Country:US
Mailing Address - Phone:714-879-5868
Mailing Address - Fax:714-879-5858
Practice Address - Street 1:305 N HARBOR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1990
Practice Address - Country:US
Practice Address - Phone:714-879-5868
Practice Address - Fax:714-879-5858
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist