Provider Demographics
NPI:1043479975
Name:GETTEL PROUT, REBECCA A (LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:GETTEL PROUT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CENTER AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5968
Mailing Address - Country:US
Mailing Address - Phone:989-670-3454
Mailing Address - Fax:
Practice Address - Street 1:315 CENTER AVE APT 403
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5968
Practice Address - Country:US
Practice Address - Phone:989-670-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010714741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical