Healthcare Provider Details

I. General information

NPI: 1104101583
Provider Name (Legal Business Name): REBECCA ANN LAWRENCE LMFT, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 ALDER RD
CRESCENT CITY CA
95531-8820
US

IV. Provider business mailing address

2721 ALDER RD
CRESCENT CITY CA
95531-8820
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-6477
  • Fax:
Mailing address:
  • Phone: 707-464-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37503
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number780931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: