Provider Demographics
NPI:1134711146
Name:SCHNAKENBERG, REBECCA (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SCHNAKENBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 W HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6416
Mailing Address - Country:US
Mailing Address - Phone:602-616-0418
Mailing Address - Fax:
Practice Address - Street 1:12717 W HOLLY ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6416
Practice Address - Country:US
Practice Address - Phone:602-616-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health