MEDICARE: REBECCA SMITH LPCC

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	101YM0800X	Mental Health Counselor	2520	MN

General Provider Information

NPI Number	:	1780157503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SMITH LPCC

Provider Business Mailing Address
First Line	:	3415 SAINT PAUL AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4342
Country	:	US
Telephone Number	:	612-284-3554
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 SAINT PAUL AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4342
Country	:	US
Telephone Number	:	612-284-3554
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	06/16/2020

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