Healthcare Provider Details

I. General information

NPI: 1255708558
Provider Name (Legal Business Name): REBECCA ANNE GILLOGLY PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 O ST STE 8
SACRAMENTO CA
95816-7179
US

IV. Provider business mailing address

3102 O ST STE 8
SACRAMENTO CA
95816-7179
US

V. Phone/Fax

Practice location:
  • Phone: 805-791-6372
  • Fax:
Mailing address:
  • Phone: 805-791-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33914
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: