Provider Demographics
NPI:1922446343
Name:SEITZ, REBECCA MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:SEITZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 FAIRWAY DR
Mailing Address - Street 2:SUITE A2
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-4023
Mailing Address - Country:US
Mailing Address - Phone:573-544-4023
Mailing Address - Fax:573-592-1660
Practice Address - Street 1:2625 FAIRWAY DR
Practice Address - Street 2:SUITE A2
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-4023
Practice Address - Country:US
Practice Address - Phone:573-544-4023
Practice Address - Fax:573-592-1660
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0033471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO140522170134550Medicaid