Provider Demographics
NPI:1912337775
Name:MANN, REBECCA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ELIZABETH
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-0243
Mailing Address - Country:US
Mailing Address - Phone:406-880-2352
Mailing Address - Fax:
Practice Address - Street 1:310 N 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2412
Practice Address - Country:US
Practice Address - Phone:406-880-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC 49231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical