Healthcare Provider Details

I. General information

NPI: 1013232172
Provider Name (Legal Business Name): RACHIDA BEJJA MSED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10828 COLDWATER RD
FORT WAYNE IN
46845-1241
US

IV. Provider business mailing address

10828 COLDWATER RD
FORT WAYNE IN
46845-1241
US

V. Phone/Fax

Practice location:
  • Phone: 260-415-8267
  • Fax: 260-426-0270
Mailing address:
  • Phone: 260-415-8267
  • Fax: 260-426-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number655-3-1-10A
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002384A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: