Provider Demographics
NPI:1902818503
Name:BARNES, REBECCA K (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:BARNES
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 1:870 VENTURA ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9585
Mailing Address - Country:US
Mailing Address - Phone:208-596-8186
Mailing Address - Fax:
Practice Address - Street 1:870 VENTURA ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9585
Practice Address - Country:US
Practice Address - Phone:208-596-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 2875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional