Healthcare Provider Details

I. General information

NPI: 1588039713
Provider Name (Legal Business Name): REBECCA BLENZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C121
LA JOLLA CA
92037-1707
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 858-768-0028
  • Fax: 858-768-0068
Mailing address:
  • Phone: 916-576-7900
  • Fax: 916-277-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: