Provider Demographics
NPI:1497549679
Name:HARRELL, REBECCA ANNE I (LCPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:HARRELL
Suffix:I
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 N KELLOGG ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-7609
Mailing Address - Country:US
Mailing Address - Phone:309-343-0800
Mailing Address - Fax:309-343-0802
Practice Address - Street 1:575 N KELLOGG ST STE 4
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-7609
Practice Address - Country:US
Practice Address - Phone:309-343-0800
Practice Address - Fax:309-343-0802
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490102721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical