Provider Demographics
NPI:1811120900
Name:LOTHE, REBECCA JEAN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:LOTHE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2929
Mailing Address - Country:US
Mailing Address - Phone:952-920-9332
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2929
Practice Address - Country:US
Practice Address - Phone:952-920-9332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional