Provider Demographics
NPI:1134318934
Name:FORTNER, REBEKKAH CATHERINE (MMPP)
Entity Type:Individual
Prefix:MISS
First Name:REBEKKAH
Middle Name:CATHERINE
Last Name:FORTNER
Suffix:
Gender:F
Credentials:MMPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 FIELDSTONE LN
Mailing Address - Street 2:M65
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-4203
Mailing Address - Country:US
Mailing Address - Phone:501-351-0859
Mailing Address - Fax:501-594-5200
Practice Address - Street 1:12100 FIELDSTONE LN
Practice Address - Street 2:M65
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-4203
Practice Address - Country:US
Practice Address - Phone:501-351-0859
Practice Address - Fax:501-594-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor