Provider Demographics
NPI:1881116390
Name:REBECK, MATT CARSON (EDD)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:CARSON
Last Name:REBECK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 JOHN ST STE 135
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-2746
Mailing Address - Country:US
Mailing Address - Phone:812-236-1911
Mailing Address - Fax:812-682-6124
Practice Address - Street 1:815 JOHN ST STE 135
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2746
Practice Address - Country:US
Practice Address - Phone:812-236-1911
Practice Address - Fax:812-682-6124
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1621448103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool