Provider Demographics
NPI:1851025951
Name:GUMM, REBEKAH NICOLE (LCPC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:NICOLE
Last Name:GUMM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 EXPEDITION DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9646
Mailing Address - Country:US
Mailing Address - Phone:406-880-7450
Mailing Address - Fax:
Practice Address - Street 1:2315 MCDONALD AVE STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7343
Practice Address - Country:US
Practice Address - Phone:406-880-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-56895101YP2500X
MTBBH-LCPC-LIC-70433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty