Provider Demographics
NPI:1871131185
Name:STEPHENS, REBECCA (LMFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 CAMARILLO ST APT 305
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3548
Mailing Address - Country:US
Mailing Address - Phone:203-788-7149
Mailing Address - Fax:
Practice Address - Street 1:28720 ROADSIDE DR STE 230
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-6008
Practice Address - Country:US
Practice Address - Phone:203-788-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist