Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401010791 | MI |
NPI | 1003156860 |
---|---|
Provider Name | Rebekah S Clancy |
First Address | Coldwater, MI 49036-1767 |
Second Address | Coldwater, MI 49036-1767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2013 |
Last Update Date | 15/02/2013 |