Provider Demographics
NPI:1437482619
Name:BAXTER, REBECCA D (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12122 TESSON FERRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-0002
Mailing Address - Country:US
Mailing Address - Phone:314-842-2074
Mailing Address - Fax:314-842-2074
Practice Address - Street 1:12122 TESSON FERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-0002
Practice Address - Country:US
Practice Address - Phone:314-842-2074
Practice Address - Fax:314-842-2074
Is Sole Proprietor?:No
Enumeration Date:2009-09-06
Last Update Date:2009-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009027396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional