Individual
REBECCA KUSHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
924 EMERALD BAY RD STE A2, SOUTH LAKE TAHOE, CA 96150-6434
(530) 544-2111
Mailing address
924 EMERALD BAY RD STE A2, SOUTH LAKE TAHOE, CA 96150-6434
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
16874
CA
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225600000X
Dance Therapist
—
—
Other
Enumeration date
09/08/2022
Last updated
06/27/2024
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