Provider Demographics
NPI:1518010735
Name:PATRICK, REBEKAH DRIESSEN (MA, LCPC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DRIESSEN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:MS
Other - First Name:REBEKAH
Other - Middle Name:LEIGH
Other - Last Name:DRIESSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1807 W DICKERSON ST STE D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1311
Mailing Address - Country:US
Mailing Address - Phone:406-600-3300
Mailing Address - Fax:406-551-1055
Practice Address - Street 1:1807 W DICKERSON ST STE D
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1311
Practice Address - Country:US
Practice Address - Phone:406-600-3300
Practice Address - Fax:406-551-1055
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT30892106H00000X
CA47593106H00000X
MT33034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist