Provider Demographics
NPI:1609231034
Name:RISTOW, REBECCA (LMHP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RISTOW
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6801
Mailing Address - Country:US
Mailing Address - Phone:402-613-8135
Mailing Address - Fax:531-500-5815
Practice Address - Street 1:6911 VAN DORN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6801
Practice Address - Country:US
Practice Address - Phone:402-613-8135
Practice Address - Fax:531-500-5815
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2177101YM0800X
NE4978101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health