Provider Demographics
NPI:1265206379
Name:KING, REBECCA DEANNE (LEP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DEANNE
Last Name:KING
Suffix:
Gender:
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-9157
Mailing Address - Country:US
Mailing Address - Phone:661-376-3683
Mailing Address - Fax:
Practice Address - Street 1:20300 W VALLEY BLVD STE C
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8609
Practice Address - Country:US
Practice Address - Phone:661-376-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist