Provider Demographics
NPI:1982730164
Name:MUYRES, REBECCA (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MUYRES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 S LEE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5746
Mailing Address - Country:US
Mailing Address - Phone:770-648-2500
Mailing Address - Fax:470-466-0500
Practice Address - Street 1:4315 S LEE ST STE 100
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5746
Practice Address - Country:US
Practice Address - Phone:770-727-1482
Practice Address - Fax:470-466-0500
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003186839AMedicaid