Provider Demographics
NPI:1093828063
Name:BAKKE, REBECCA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BAKKE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 HINSON RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3474
Mailing Address - Country:US
Mailing Address - Phone:501-224-0318
Mailing Address - Fax:501-224-0354
Practice Address - Street 1:12115 HINSON RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3474
Practice Address - Country:US
Practice Address - Phone:501-224-0318
Practice Address - Fax:501-224-0354
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006721101YP2500X
MO2011003229101YP2500X
ARP1603031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional