Provider Demographics
NPI:1346420544
Name:WHITED, REBECCA J (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:WHITED
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2457
Mailing Address - Country:US
Mailing Address - Phone:219-921-0705
Mailing Address - Fax:219-921-0557
Practice Address - Street 1:215 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2457
Practice Address - Country:US
Practice Address - Phone:219-921-0705
Practice Address - Fax:219-921-0557
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001639A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health