Provider Demographics
NPI:1629277181
Name:KNOWLES, REBECCA JANE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JANE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 AUTUMN SAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7732
Mailing Address - Country:US
Mailing Address - Phone:505-350-5937
Mailing Address - Fax:505-824-4388
Practice Address - Street 1:204 AUTUMN SAGE LN
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7732
Practice Address - Country:US
Practice Address - Phone:505-350-5937
Practice Address - Fax:505-824-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0080801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM101318Medicaid