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General NPI Number Information
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NPI Number | 1013514728
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Entity Type | Organization
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Legal Business Name | REBECCA RAND COUNSELING LLC
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 136 S ACADEMY AVE STE G
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City | EAGLE
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State | ID
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Zip | 83616-6541
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Country | US
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Telephone | 208-912-6621
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Fax | 208-939-9110
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Provider Business Mailing Address
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Address Line | 2886 E FERN BROOK DR
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City | EAGLE
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State | ID
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Zip | 83616-6602
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Country | US
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Telephone | 208-912-6621
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | MONICA MATHIS
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Credential |
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Telephone | 954-261-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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