Provider Demographics
NPI:1275212714
Name:BARROM, REBEKAH RAY (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:RAY
Last Name:BARROM
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-7851
Mailing Address - Country:US
Mailing Address - Phone:901-412-6803
Mailing Address - Fax:
Practice Address - Street 1:2180 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4205
Practice Address - Country:US
Practice Address - Phone:901-412-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health