Healthcare Provider Details

I. General information

NPI: 1134349616
Provider Name (Legal Business Name): REBEKAH A CLINE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S UNION AVE SUITE 16
TACOMA WA
98405-1954
US

IV. Provider business mailing address

1530 S UNION AVE SUITE 16
TACOMA WA
98405-1954
US

V. Phone/Fax

Practice location:
  • Phone: 253-756-0323
  • Fax: 253-756-0427
Mailing address:
  • Phone: 253-756-0323
  • Fax: 253-756-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY60067812
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: