Provider Demographics
NPI:1154186856
Name:PETTEFER, REBECCA CAROLINE (PLPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CAROLINE
Last Name:PETTEFER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N COVEY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1316
Mailing Address - Country:US
Mailing Address - Phone:337-429-1233
Mailing Address - Fax:
Practice Address - Street 1:1117 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5317
Practice Address - Country:US
Practice Address - Phone:337-414-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health