1114360732 NPI number — REBEL BT CRAIG LPCC

Table of content: REBEL BT CRAIG LPCC (NPI 1114360732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114360732 NPI number — REBEL BT CRAIG LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
REBEL
Provider Middle Name:
BT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRAIG
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114360732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 F STREET, SUITE 3
Provider Second Line Business Mailing Address:
#725
Provider Business Mailing Address City Name:
ARCATA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-244-1938
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 F STREET, SUITE 3
Provider Second Line Business Practice Location Address:
#725
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-244-1938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPCC4505 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)