Provider Demographics
NPI:1285745596
Name:BIANCO, REBECCA J (MA, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BIANCO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BERRING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3475 MOUNTAINSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4858
Mailing Address - Country:US
Mailing Address - Phone:719-599-0581
Mailing Address - Fax:
Practice Address - Street 1:220 RUSKIN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2522
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional