Provider Demographics
NPI:1407327539
Name:NORTH, REBEKAH (BCBA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:NORTH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3960 IVYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2567
Mailing Address - Country:US
Mailing Address - Phone:719-565-1276
Mailing Address - Fax:719-565-2313
Practice Address - Street 1:3960 IVYWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2567
Practice Address - Country:US
Practice Address - Phone:719-565-1276
Practice Address - Fax:719-565-2313
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-50486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst