Provider Demographics
NPI:1780025965
Name:COTTLE, REBEKAH BURKE (LMFT, CSW)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:BURKE
Last Name:COTTLE
Suffix:
Gender:F
Credentials:LMFT, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4905
Mailing Address - Country:US
Mailing Address - Phone:502-882-0225
Mailing Address - Fax:
Practice Address - Street 1:125 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4905
Practice Address - Country:US
Practice Address - Phone:502-882-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6750104100000X
KYMFTMFT00223555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker