Provider Demographics
NPI:1255639332
Name:REBECCA JANE KNOWLES
Entity type:Organization
Organization Name:REBECCA JANE KNOWLES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-824-4388
Mailing Address - Street 1:204 AUTUMN SAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7732
Mailing Address - Country:US
Mailing Address - Phone:575-824-4388
Mailing Address - Fax:575-824-0521
Practice Address - Street 1:204 AUTUMN SAGE LN
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7732
Practice Address - Country:US
Practice Address - Phone:575-824-4388
Practice Address - Fax:575-824-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0080801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty