Healthcare Provider Details

I. General information

NPI: 1487365516
Provider Name (Legal Business Name): REBECCA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NW 5TH ST
OKEECHOBEE FL
34972-2565
US

IV. Provider business mailing address

8473 QUARTER HORSE DR
RIVERVIEW FL
33578-8897
US

V. Phone/Fax

Practice location:
  • Phone: 813-787-0239
  • Fax:
Mailing address:
  • Phone: 813-787-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: