Provider Demographics
NPI:1538533948
Name:REBECCA S. DE VRIES, PH.D., LLC
Entity type:Organization
Organization Name:REBECCA S. DE VRIES, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DE VRIES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, NCSP
Authorized Official - Phone:724-766-2376
Mailing Address - Street 1:104 CASHDOLLAR RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3502
Mailing Address - Country:US
Mailing Address - Phone:724-766-2376
Mailing Address - Fax:844-662-5069
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:SUITE 102A
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5991
Practice Address - Country:US
Practice Address - Phone:724-766-2376
Practice Address - Fax:844-662-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1588983894OtherNPPES