Healthcare Provider Details

I. General information

NPI: 1336679190
Provider Name (Legal Business Name): REBECCA LANGE STRAYER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # 6019
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4124
  • Fax: 513-636-4283
Mailing address:
  • Phone: 513-636-5278
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1700409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: