Provider Demographics
NPI:1326243205
Name:FREY, REBECCA ISMART (MS, LMFT, QMHP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ISMART
Last Name:FREY
Suffix:
Gender:F
Credentials:MS, LMFT, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 UPPER BRECKENRIDGE LOOP NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3435
Mailing Address - Country:US
Mailing Address - Phone:301-651-3484
Mailing Address - Fax:
Practice Address - Street 1:965 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4138
Practice Address - Country:US
Practice Address - Phone:503-588-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
ORT0662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health