Provider Demographics
NPI:1023151065
Name:REHBERG, KATHRYN LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LEE
Last Name:REHBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 990273
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0273
Mailing Address - Country:US
Mailing Address - Phone:530-356-1864
Mailing Address - Fax:530-760-4123
Practice Address - Street 1:1650 OREGON ST STE 209
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1757
Practice Address - Country:US
Practice Address - Phone:530-435-6092
Practice Address - Fax:530-215-1444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHD168AMedicare UPIN