Healthcare Provider Details

I. General information

NPI: 1851025951
Provider Name (Legal Business Name): REBEKAH NICOLE GUMM LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SW HIGGINS AVE STE 201
MISSOULA MT
59803-1340
US

IV. Provider business mailing address

5560 EXPEDITION DR
LOLO MT
59847-9646
US

V. Phone/Fax

Practice location:
  • Phone: 406-880-7450
  • Fax:
Mailing address:
  • Phone: 406-880-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-56895
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-70433
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: