Provider Demographics
NPI:1255345385
Name:LAND, REBEKAH RUTH (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:RUTH
Last Name:LAND
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4513
Mailing Address - Country:US
Mailing Address - Phone:615-376-4818
Mailing Address - Fax:615-376-2844
Practice Address - Street 1:761 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4513
Practice Address - Country:US
Practice Address - Phone:615-376-4818
Practice Address - Fax:615-376-2844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000367101YP2500X
TX8746101YP2500X
TNLSW00000031411041C0700X
TNLMT0000000133106H00000X
TX003140-039320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3696770Medicaid
TN3696770Medicare ID - Type Unspecified