Provider Demographics
NPI:1144932286
Name:HUGHES, REBECCA A (TLLP, MA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HUGHES
Suffix:
Gender:F
Credentials:TLLP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E MUSKEGON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1524
Mailing Address - Country:US
Mailing Address - Phone:231-670-4328
Mailing Address - Fax:
Practice Address - Street 1:1475 ROBBINS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3700
Practice Address - Country:US
Practice Address - Phone:616-315-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000783103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist