Provider Demographics
NPI:1568769800
Name:FUELBERTH, REBECCA JEAN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:FUELBERTH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:IL
Mailing Address - Zip Code:61535-9401
Mailing Address - Country:US
Mailing Address - Phone:309-453-6048
Mailing Address - Fax:
Practice Address - Street 1:208 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2044
Practice Address - Country:US
Practice Address - Phone:309-453-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional