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NPI Code Detail

MEDICARE: MRS. REBECCA JEAN FUELBERTH LCPC

MEDICARE: MRS. REBECCA JEAN FUELBERTH LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180.007711IL

General Provider Information

NPI Number : 1568769800
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA JEAN FUELBERTH LCPC
Provider Business Mailing Address
First Line : 123 CHEROKEE DR
Second Line :
City : GROVELAND
State : IL
Zip : 61535-9401
Country : US
Telephone Number : 309-453-6048
Fax Number :
Provider Business Practice Location Address
First Line : 208 S 1ST AVE
Second Line :
City : MORTON
State : IL
Zip : 61550-2044
Country : US
Telephone Number : 309-453-6048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2011
Last Update Date : 11/16/2020

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