Provider Demographics
NPI:1457096869
Name:FURNISS, REBEKAH LILLIAN
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LILLIAN
Last Name:FURNISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1612
Mailing Address - Country:US
Mailing Address - Phone:435-228-6523
Mailing Address - Fax:
Practice Address - Street 1:754 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1612
Practice Address - Country:US
Practice Address - Phone:435-228-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical