Provider Demographics
NPI:1326896333
Name:PRICE, REBECCA (LPC-MHSP(TEMP))
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LPC-MHSP(TEMP)
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:AC
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP(TEMP), NCC
Mailing Address - Street 1:57 GERMANTOWN CT STE 200
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4268
Mailing Address - Country:US
Mailing Address - Phone:901-264-9436
Mailing Address - Fax:
Practice Address - Street 1:57 GERMANTOWN CT STE 200
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4268
Practice Address - Country:US
Practice Address - Phone:901-264-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health