Provider Demographics
NPI:1306035787
Name:LACHUT, REBECCA MARTIN (LMHC LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARTIN
Last Name:LACHUT
Suffix:
Gender:F
Credentials:LMHC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2058
Mailing Address - Country:US
Mailing Address - Phone:904-448-4700
Mailing Address - Fax:904-783-1901
Practice Address - Street 1:4595 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2058
Practice Address - Country:US
Practice Address - Phone:904-448-4700
Practice Address - Fax:904-783-1901
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2468106H00000X
FLMH 10072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health