Provider Demographics
NPI:1528260957
Name:SCHULTHEIS, REBECCA LYNNE (LMFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:SCHULTHEIS
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 1:5523 SCOTTS VALLEY DR STE 209
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3450
Mailing Address - Country:US
Mailing Address - Phone:831-250-6962
Mailing Address - Fax:
Practice Address - Street 1:5523 SCOTTS VALLEY DR STE 209
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3450
Practice Address - Country:US
Practice Address - Phone:831-250-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT102616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82-3465144OtherMEDI-CAL