Provider Demographics
NPI:1760695829
Name:DOAN, REBECCA L (MS CADC III, NCAC II)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:DOAN
Suffix:
Gender:F
Credentials:MS CADC III, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-0091
Mailing Address - Country:US
Mailing Address - Phone:316-322-7057
Mailing Address - Fax:
Practice Address - Street 1:226 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2146
Practice Address - Country:US
Practice Address - Phone:316-322-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS848OtherLPC