Provider Demographics
NPI:1013542869
Name:HOLKENBRINK, REBECCA (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HOLKENBRINK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2128
Mailing Address - Country:US
Mailing Address - Phone:217-342-7000
Mailing Address - Fax:217-342-7002
Practice Address - Street 1:1106 N MERCHANT ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2128
Practice Address - Country:US
Practice Address - Phone:217-342-7000
Practice Address - Fax:217-342-7002
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional