Provider Demographics
NPI:1265841803
Name:LARSON, REBEKAH MAY (CIT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MAY
Last Name:LARSON
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 SUTTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3910
Mailing Address - Country:US
Mailing Address - Phone:314-881-8410
Mailing Address - Fax:888-717-4730
Practice Address - Street 1:3134 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3910
Practice Address - Country:US
Practice Address - Phone:314-881-8410
Practice Address - Fax:888-717-4730
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor