Provider Demographics
NPI:1104525757
Name:SCHACK, REBECCA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:SCHACK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2541
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-2541
Mailing Address - Country:US
Mailing Address - Phone:805-640-5694
Mailing Address - Fax:
Practice Address - Street 1:680 E COLORADO BLVD STE 180
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6144
Practice Address - Country:US
Practice Address - Phone:805-640-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist