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NPI Code Detail

MEDICARE: REBECCA CAROLINE PETTEFER PLPC

MEDICARE: REBECCA CAROLINE PETTEFER PLPC
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
1101YM0800XMental Health CounselorPLC10015LA

General Provider Information

NPI Number : 1154186856
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA CAROLINE PETTEFER PLPC
Provider Business Mailing Address
First Line : 1514 N COVEY LN
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-1316
Country : US
Telephone Number : 337-429-1233
Fax Number :
Provider Business Practice Location Address
First Line : 1117 KIRKMAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-5317
Country : US
Telephone Number : 337-414-8379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2024
Last Update Date : 02/21/2024

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Directions to “ REBECCA CAROLINE PETTEFER PLPC” Practice Location

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