Provider Demographics
NPI:1871006957
Name:POINDEXTER, REBECCA DIANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DIANE
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 DRY BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4148
Mailing Address - Country:US
Mailing Address - Phone:636-290-6045
Mailing Address - Fax:314-953-8150
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-953-8101
Practice Address - Fax:314-953-8150
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017036053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017036053Medicaid