Provider Demographics
NPI:1942698956
Name:REBHOLZ, CHRISTINA HEATHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:HEATHER
Last Name:REBHOLZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 BRACKEN PL SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9235
Mailing Address - Country:US
Mailing Address - Phone:425-292-3318
Mailing Address - Fax:
Practice Address - Street 1:10512 NE 68TH ST
Practice Address - Street 2:SUITE C-104
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7002
Practice Address - Country:US
Practice Address - Phone:425-606-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60454165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical