Provider Demographics
NPI:1588918262
Name:SPANN, REBECCA RENEE (EDS, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RENEE
Last Name:SPANN
Suffix:
Gender:F
Credentials:EDS, LPC, NCC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1939 S DIVISION AVE.
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507
Mailing Address - Country:US
Mailing Address - Phone:616-247-3815
Mailing Address - Fax:616-245-0450
Practice Address - Street 1:1939 S DIVISION AVE.
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507
Practice Address - Country:US
Practice Address - Phone:616-247-3815
Practice Address - Fax:616-245-0450
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional