Provider Demographics
NPI:1578837555
Name:ADAMS, REBECCA J (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 MALVERN ST.
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:763-600-7572
Mailing Address - Fax:844-407-4565
Practice Address - Street 1:411 3RD ST SE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1606
Practice Address - Country:US
Practice Address - Phone:763-600-7572
Practice Address - Fax:844-407-4565
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty