Provider Demographics
NPI:1386093334
Name:HENTGES, RHISIE (LMFT)
Entity type:Individual
Prefix:
First Name:RHISIE
Middle Name:
Last Name:HENTGES
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 1:5040 KATELLA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2802
Mailing Address - Country:US
Mailing Address - Phone:562-888-1774
Mailing Address - Fax:
Practice Address - Street 1:5040 KATELLA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2802
Practice Address - Country:US
Practice Address - Phone:562-888-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist