Healthcare Provider Details

I. General information

NPI: 1962572057
Provider Name (Legal Business Name): REBECCA E KLEIHEGE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 Q ST
BEDFORD IN
47421-4718
US

IV. Provider business mailing address

2325 Q ST
BEDFORD IN
47421-4718
US

V. Phone/Fax

Practice location:
  • Phone: 812-279-4673
  • Fax: 812-279-4672
Mailing address:
  • Phone: 812-279-4673
  • Fax: 812-279-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001767A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: