Provider Demographics
NPI:1669240164
Name:JORGENSEN, REBECCA P (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 VERSAILLES CT
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4409
Mailing Address - Country:US
Mailing Address - Phone:619-694-6433
Mailing Address - Fax:
Practice Address - Street 1:736 S 900 E STE 203-D
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7000
Practice Address - Country:US
Practice Address - Phone:385-777-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11330500-6004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor