Provider Demographics
NPI:1942863766
Name:STOKES, REBECCA MARIE (PCLC 37573)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:STOKES
Suffix:
Gender:F
Credentials:PCLC 37573
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8535 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8922
Mailing Address - Country:US
Mailing Address - Phone:406-579-9303
Mailing Address - Fax:
Practice Address - Street 1:65 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6052
Practice Address - Country:US
Practice Address - Phone:406-579-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health