Healthcare Provider Details

I. General information

NPI: 1376943837
Provider Name (Legal Business Name): REBECCA JANE HEINS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 03/16/2021
Certification Date: 02/22/2021
Deactivation Date: 02/02/2021
Reactivation Date: 02/22/2021

III. Provider practice location address

11333 MOORPARK ST # 28
STUDIO CITY CA
91602-2618
US

IV. Provider business mailing address

11333 MOORPARK ST # 28
STUDIO CITY CA
91602-2618
US

V. Phone/Fax

Practice location:
  • Phone: 310-896-5178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: