Provider Demographics
NPI:1659697589
Name:KOLL, REBEKAH GRACE
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:GRACE
Last Name:KOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6805
Mailing Address - Country:US
Mailing Address - Phone:605-366-0724
Mailing Address - Fax:
Practice Address - Street 1:501 S JOHNSTONE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6622
Practice Address - Country:US
Practice Address - Phone:918-337-0900
Practice Address - Fax:918-337-6061
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health