Provider Demographics
NPI:1932351756
Name:TAYLOR, REBEKAH (LCSW)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
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 142
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-0142
Mailing Address - Country:US
Mailing Address - Phone:479-647-9728
Mailing Address - Fax:
Practice Address - Street 1:116 S FRONT STREET
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4028
Practice Address - Country:US
Practice Address - Phone:479-647-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1132861041C0700X
MN317551041C0700X
WALW613627441041C0700X
AZLCSW-192781041C0700X
FLSW194581041C0700X
AR5873-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical