Provider Demographics
NPI:1811677701
Name:WILSON, REBEKAH CHEREE' (SUPERVISEE LADC LPC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:CHEREE'
Last Name:WILSON
Suffix:
Gender:F
Credentials:SUPERVISEE LADC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9726 E 42ND ST STE 106
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3673
Mailing Address - Country:US
Mailing Address - Phone:918-712-7711
Mailing Address - Fax:
Practice Address - Street 1:9726 E 42ND ST STE 106
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3673
Practice Address - Country:US
Practice Address - Phone:918-712-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral