Healthcare Provider Details

I. General information

NPI: 1184094591
Provider Name (Legal Business Name): REBECCA BECKY TEKEIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD SUITE 215
REDLANDS CA
92373-4775
US

IV. Provider business mailing address

101 E REDLANDS BLVD SUITE 215
REDLANDS CA
92373-4775
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: