=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578059754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBEKAH SCOTT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2018
-----------------------------------------------------
Last Update Date | 10/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2214 E. ELM GROVE DR.
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83686-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-573-1273
-----------------------------------------------------
Fax | 208-437-7488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2214 E. ELM GROVE DR.
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83686-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-573-1273
-----------------------------------------------------
Fax | 208-437-7488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. REBEKAH RENE SCOTT
-----------------------------------------------------
Credential | MA, LPC, CCTP-II
-----------------------------------------------------
Telephone | 208-573-1273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------