Provider Demographics
NPI:1013543339
Name:COONEN, REBEKAH N (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:N
Last Name:COONEN
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4759
Mailing Address - Country:US
Mailing Address - Phone:406-457-0000
Mailing Address - Fax:406-500-2128
Practice Address - Street 1:1930 9TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4759
Practice Address - Country:US
Practice Address - Phone:406-457-0000
Practice Address - Fax:406-500-2128
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-63796101YA0400X
MTBBH-LCPC-LIC-43993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-63796OtherMONTANA BOARD OF BEHAVIORAL HEALTH
14609602OtherCAQH PROVIEW
MTBBH-LCPC-LIC-43993OtherMONTANA BOARD OF BEHAVIORAL HEALTH