Provider Demographics
NPI:1811323462
Name:CHILDS, REBECCA PEARL (LMHC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:PEARL
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 W SMITH VALLEY RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8495
Mailing Address - Country:US
Mailing Address - Phone:317-884-5075
Mailing Address - Fax:317-884-5076
Practice Address - Street 1:3209 W SMITH VALLEY RD
Practice Address - Street 2:SUITE 226
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8495
Practice Address - Country:US
Practice Address - Phone:317-884-5075
Practice Address - Fax:317-884-5076
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002522A101YM0800X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral