Provider Demographics
NPI:1871620567
Name:HALL, REBECCA MARIE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1077
Mailing Address - Country:US
Mailing Address - Phone:707-822-2551
Mailing Address - Fax:707-822-2667
Practice Address - Street 1:739 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6209
Practice Address - Country:US
Practice Address - Phone:707-822-2551
Practice Address - Fax:707-822-2667
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist