Provider Demographics
NPI:1053177154
Name:PANARRA, REBECCA LYNN (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:PANARRA
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 FARROLL RD
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2649
Mailing Address - Country:US
Mailing Address - Phone:209-202-5870
Mailing Address - Fax:
Practice Address - Street 1:3889 LONG ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7581
Practice Address - Country:US
Practice Address - Phone:805-724-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15580101YP2500X
CA144345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional