=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770002909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & R MENTAL HEALTH COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 01/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 W JOHNSON RD
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46350-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-706-7907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 GLENEAGLES BLVD APT N
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-2875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | REBECCA ROWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-706-7907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------