Provider Demographics
NPI:1629491576
Name:MCGINNIS, REBA (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 STATE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2233
Mailing Address - Country:US
Mailing Address - Phone:270-796-2012
Mailing Address - Fax:270-796-2841
Practice Address - Street 1:918 STATE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2233
Practice Address - Country:US
Practice Address - Phone:270-796-2012
Practice Address - Fax:270-796-2841
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health