MEDICARE: MRS. REBECCA DIANE DAVIS HOLLAND LPC

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
1	101YP2500X	Professional Counselor	1430	OK

General Provider Information

NPI Number	:	1598929390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA DIANE DAVIS HOLLAND LPC

Provider Business Mailing Address
First Line	:	13200 BIG SKY ROAD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-7705
Country	:	US
Telephone Number	:	405-330-4903
Fax Number	:

Provider Business Practice Location Address
First Line	:	12032 N PENN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7827
Country	:	US
Telephone Number	:	405-255-9574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/11/2008

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