Provider Demographics
NPI:1427049394
Name:FREESE, REBEKAH A (LCSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:A
Last Name:FREESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N GARTH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4103
Mailing Address - Country:US
Mailing Address - Phone:573-449-2581
Mailing Address - Fax:573-449-2583
Practice Address - Street 1:117 N GARTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4103
Practice Address - Country:US
Practice Address - Phone:573-449-2581
Practice Address - Fax:573-449-2583
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024548101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649269622OtherGROUP BILLING NPI
MO431008405OtherGROUP TAX I.D.
MO193115OtherBCBS I.D.
MO497307504Medicaid
MO506201904OtherHCY MEDICAID NUMBER