Provider Demographics
NPI:1780035709
Name:COULL, REBECCA (MFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COULL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 S 2ND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8734
Mailing Address - Country:US
Mailing Address - Phone:814-900-4510
Mailing Address - Fax:814-900-4511
Practice Address - Street 1:162 SOUTH 2ND AVE
Practice Address - Street 2:D
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1621
Practice Address - Country:US
Practice Address - Phone:814-900-4510
Practice Address - Fax:814-900-4511
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist