Healthcare Provider Details

I. General information

NPI: 1326896333
Provider Name (Legal Business Name): REBECCA PRICE LPC-MHSP(TEMP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA A.C. PRICE LPC-MHSP(TEMP), NCC

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GERMANTOWN CT STE 200
CORDOVA TN
38018-4268
US

IV. Provider business mailing address

57 GERMANTOWN CT STE 200
CORDOVA TN
38018-4268
US

V. Phone/Fax

Practice location:
  • Phone: 901-264-9436
  • Fax:
Mailing address:
  • Phone: 901-264-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6208
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: