MEDICARE: REBECCA LYNNE VAN BAALE TLMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	123812	IA

General Provider Information

NPI Number	:	1134990013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNNE VAN BAALE TLMHC

Provider Business Mailing Address
First Line	:	107 DAWN AVE
Second Line	:
City	:	MONROE
State	:	IA
Zip	:	50170-7544
Country	:	US
Telephone Number	:	641-840-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 1ST AVE E
Second Line	:
City	:	NEWTON
State	:	IA
Zip	:	50208-4049
Country	:	US
Telephone Number	:	641-275-3520
Fax Number	:	641-275-3522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/10/2024

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