MEDICARE: MRS. BECKY LYNN VERBANSKY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	43933	CA

General Provider Information

NPI Number	:	1790848208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BECKY LYNN VERBANSKY LMFT

Provider Business Mailing Address
First Line	:	16155 SIERRA LAKES PKWY
Second Line	:	SUITE 160-602
City	:	FONTANA
State	:	CA
Zip	:	92336-1244
Country	:	US
Telephone Number	:	909-963-6164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 E WARNER RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-3065
Country	:	US
Telephone Number	:	909-963-6164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	03/17/2025

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