Provider Demographics
NPI:1841486255
Name:ALLEN, REBECCA (MS,LPC,NCC,NCSC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS,LPC,NCC,NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83103
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39283-3103
Mailing Address - Country:US
Mailing Address - Phone:601-981-9778
Mailing Address - Fax:601-981-9778
Practice Address - Street 1:4550 MANHATTAN RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-6022
Practice Address - Country:US
Practice Address - Phone:601-981-9778
Practice Address - Fax:601-981-9778
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1084101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor