Provider Demographics
NPI:1457503146
Name:RABASTE, MYRIAM DANIELLE JEANNE (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:MYRIAM
Middle Name:DANIELLE JEANNE
Last Name:RABASTE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15899 ARNOLD RD
Mailing Address - Street 2:APT A
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9029
Mailing Address - Country:US
Mailing Address - Phone:303-856-4326
Mailing Address - Fax:
Practice Address - Street 1:15899 ARNOLD RD
Practice Address - Street 2:APT A
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618-9029
Practice Address - Country:US
Practice Address - Phone:303-856-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health