=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841486255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA ALLEN M.S.,LPC,NCC,NCSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 09/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4550 MANHATTAN RD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39206-6022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-981-9778
-----------------------------------------------------
Fax | 601-981-9778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 83103
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39283-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-981-9778
-----------------------------------------------------
Fax | 601-981-9778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 1084
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------