Provider Demographics
NPI:1851091748
Name:FELLER, REBEKAH (CB61419138)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:FELLER
Suffix:
Gender:F
Credentials:CB61419138
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 ASPENWAY DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-6601
Mailing Address - Country:US
Mailing Address - Phone:406-249-6412
Mailing Address - Fax:
Practice Address - Street 1:10817 206TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8841
Practice Address - Country:US
Practice Address - Phone:253-861-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61419138106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician