Provider Demographics
NPI:1013232172
Name:BEJJA, RACHIDA (MSED, LMHC)
Entity Type:Individual
Prefix:
First Name:RACHIDA
Middle Name:
Last Name:BEJJA
Suffix:
Gender:F
Credentials:MSED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10828 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1241
Mailing Address - Country:US
Mailing Address - Phone:260-415-8267
Mailing Address - Fax:260-426-0270
Practice Address - Street 1:10828 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1241
Practice Address - Country:US
Practice Address - Phone:260-415-8267
Practice Address - Fax:260-426-0270
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND655-3-1-10A101YP2500X
IN39002384A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional