Provider Demographics
NPI:1497290787
Name:BAXTER, REBECCA SUE (PLPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:BAXTER
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 1:7800 NW LYNNS LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERBY LAKE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1560
Mailing Address - Country:US
Mailing Address - Phone:479-200-9035
Mailing Address - Fax:
Practice Address - Street 1:8301 STATE LINE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2025
Practice Address - Country:US
Practice Address - Phone:479-200-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016044486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health