Provider Demographics
NPI:1811391642
Name:REBH, ADAM (PCC-SUPV)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REBH
Suffix:
Gender:M
Credentials:PCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4861
Mailing Address - Country:US
Mailing Address - Phone:234-978-2726
Mailing Address - Fax:330-966-1550
Practice Address - Street 1:140 GRAND TRUNK AVE SW STE G
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9681
Practice Address - Country:US
Practice Address - Phone:234-978-2726
Practice Address - Fax:330-966-1550
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0700205-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional