Healthcare Provider Details

I. General information

NPI: 1194195388
Provider Name (Legal Business Name): REBECCA SHEERAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 03/25/2024
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5594 AISEK ST
JUNEAU AK
99801
US

IV. Provider business mailing address

5597 AISEK ST
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-419-7038
  • Fax:
Mailing address:
  • Phone: 907-419-7038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101345
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: