Provider Demographics
NPI:1629455928
Name:JABARA, REBECCA LYNN (LCP LMLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:JABARA
Suffix:
Gender:F
Credentials:LCP LMLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:STANDIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6122 SHADYBROOK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1862
Mailing Address - Country:US
Mailing Address - Phone:316-641-0606
Mailing Address - Fax:877-381-0101
Practice Address - Street 1:6122 SHADYBROOK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1862
Practice Address - Country:US
Practice Address - Phone:316-640-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1033103TC0700X
KS1479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1033OtherKANSAS BEHAVIORAL SCIENCES REGULATORY BOARD