Provider Demographics
NPI:1063258556
Name:MCLEAN, REBEKAH ANNE (MA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANNE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD STE 225
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5966
Mailing Address - Country:US
Mailing Address - Phone:208-614-0588
Mailing Address - Fax:208-203-7432
Practice Address - Street 1:2995 N COLE RD STE 225
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5966
Practice Address - Country:US
Practice Address - Phone:208-614-0588
Practice Address - Fax:208-203-7432
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFTI-10537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist