=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255665519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA RENEE SUTER LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2009
-----------------------------------------------------
Last Update Date | 04/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 S EASTERN AVE SUITE 140
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-0824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-373-4104
-----------------------------------------------------
Fax | 702-951-9385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 S EASTERN AVE SUITE 140
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-0824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-373-4104
-----------------------------------------------------
Fax | 702-951-9385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.007163
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CP0038
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------