Provider Demographics
NPI:1396244489
Name:DR. MATT C. REBECK, LLC
Entity type:Organization
Organization Name:DR. MATT C. REBECK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:REBECK
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:812-236-1911
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:NEW HARMONY
Mailing Address - State:IN
Mailing Address - Zip Code:47631-0038
Mailing Address - Country:US
Mailing Address - Phone:812-236-1911
Mailing Address - Fax:812-682-6124
Practice Address - Street 1:815 JOHN ST STE 135
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2746
Practice Address - Country:US
Practice Address - Phone:812-236-1911
Practice Address - Fax:812-682-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041439A261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health