Healthcare Provider Details

I. General information

NPI: 1619329679
Provider Name (Legal Business Name): REBECCA ANNE WASINACK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 05/13/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 IRVINE CENTER DR STE 200
IRVINE CA
92618-2933
US

IV. Provider business mailing address

17621 IRVINE BLVD STE 214
TUSTIN CA
92780-3131
US

V. Phone/Fax

Practice location:
  • Phone: 619-946-8983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122268
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF85801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: