Provider Demographics
NPI:1316702632
Name:HARRIS, REBEKAH (STUDENT INTERN)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:STUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:KETTLE ISLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40958-8943
Mailing Address - Country:US
Mailing Address - Phone:423-262-3281
Mailing Address - Fax:
Practice Address - Street 1:2010 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2829
Practice Address - Country:US
Practice Address - Phone:606-302-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY294488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional