Provider Demographics
NPI:1003355785
Name:JUAN, REBECCA (MA, LPC, CHT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JUAN
Suffix:
Gender:F
Credentials:MA, LPC, CHT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, CHT
Mailing Address - Street 1:5 UNIVERSITY CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2235
Mailing Address - Country:US
Mailing Address - Phone:303-819-1817
Mailing Address - Fax:
Practice Address - Street 1:5 UNIVERSITY CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-2235
Practice Address - Country:US
Practice Address - Phone:303-819-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014408101YM0800X
COLPCC# 0013703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health