Provider Demographics
NPI:1326454331
Name:VETH, REBECCA (PLPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:VETH
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RYLEE CIR APT A
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1377
Mailing Address - Country:US
Mailing Address - Phone:978-606-9088
Mailing Address - Fax:
Practice Address - Street 1:204 METRO DR
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4408
Practice Address - Country:US
Practice Address - Phone:573-634-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional