Basic Information
| Provider Information | |||||||||
| NPI: | 1881215432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHERN | ||||||||
| FirstName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959456410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304779800 | ||||||||
| FaxNumber: | 5304779803 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959456410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304779800 | ||||||||
| FaxNumber: | 5304779803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2020 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 123689 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.