Provider Demographics
NPI:1568054468
Name:NYSTROM, REBECCA ANN (LMHCA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 WHEATON WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3305
Mailing Address - Country:US
Mailing Address - Phone:360-362-0003
Mailing Address - Fax:
Practice Address - Street 1:2528 WHEATON WAY STE 105
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3305
Practice Address - Country:US
Practice Address - Phone:360-362-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health