Provider Demographics
NPI:1831562289
Name:FAVIA, REBEKAH LYNN (LPC, RDN)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:FAVIA
Suffix:
Gender:F
Credentials:LPC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:548 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3184
Practice Address - Country:US
Practice Address - Phone:541-388-8459
Practice Address - Fax:541-388-8116
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10166851133V00000X
ORC8089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered