Provider Demographics
NPI:1265015424
Name:REBECCA MAHAN-STRUPP, S.C.
Entity Type:Organization
Organization Name:REBECCA MAHAN-STRUPP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN-STRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:608-436-0921
Mailing Address - Street 1:11618 N MAPLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9078
Mailing Address - Country:US
Mailing Address - Phone:608-436-0921
Mailing Address - Fax:
Practice Address - Street 1:2802 COHO ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4521
Practice Address - Country:US
Practice Address - Phone:608-436-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty