Provider Demographics
NPI:1659765501
Name:PHILLIPS, REBEKAH MARIE (MS)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:MARIE
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:702 PLUMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-4115
Mailing Address - Country:US
Mailing Address - Phone:321-666-0677
Mailing Address - Fax:
Practice Address - Street 1:633 UMATILLA BLVD
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8418
Practice Address - Country:US
Practice Address - Phone:352-669-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health