Healthcare Provider Details

I. General information

NPI: 1750756714
Provider Name (Legal Business Name): REBECCA HAHN-HOOTEN LMFT 115545
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 06/16/2021
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 NORTH CYPRESS AVE
ONTARIO CA
91762
US

IV. Provider business mailing address

1030 N MOUNTAIN AVE STE 290
ONTARIO CA
91762-2114
US

V. Phone/Fax

Practice location:
  • Phone: 951-444-1647
  • Fax:
Mailing address:
  • Phone: 951-444-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF78251
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 78251
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number115545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: