Provider Demographics
NPI:1568153716
Name:EDMONSTON, REBECCA (LPC, ACC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:EDMONSTON
Suffix:
Gender:F
Credentials:LPC, ACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-0029
Mailing Address - Country:US
Mailing Address - Phone:917-318-4959
Mailing Address - Fax:
Practice Address - Street 1:2208 VAN PATTEN PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2754
Practice Address - Country:US
Practice Address - Phone:917-318-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health