Healthcare Provider Details

I. General information

NPI: 1053177154
Provider Name (Legal Business Name): REBECCA LYNN PANARRA AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 LONG ST STE 200
SAN LUIS OBISPO CA
93401-7581
US

IV. Provider business mailing address

783 FARROLL RD
GROVER BEACH CA
93433-2649
US

V. Phone/Fax

Practice location:
  • Phone: 805-724-6831
  • Fax:
Mailing address:
  • Phone: 209-202-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: