Provider Demographics
NPI:1316651896
Name:BENNETT, REBECCA K (MA, LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:K
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S JACKSON ST UNIT 343
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2875
Mailing Address - Country:US
Mailing Address - Phone:919-621-9600
Mailing Address - Fax:
Practice Address - Street 1:123 2ND AVE S
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-8457
Practice Address - Country:US
Practice Address - Phone:425-678-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61548302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health