Provider Demographics
NPI:1457617284
Name:MILLER, REBECCA L (LPCA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 51322
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5622
Mailing Address - Country:US
Mailing Address - Phone:270-777-9283
Mailing Address - Fax:270-777-1550
Practice Address - Street 1:181 W PROFESSIONAL PARK CT
Practice Address - Street 2:SUITE 1
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3250
Practice Address - Country:US
Practice Address - Phone:270-843-5300
Practice Address - Fax:270-843-5383
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional