Provider Demographics
NPI:1447072020
Name:TELEW, REBEKAH LARA (LMFTA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LARA
Last Name:TELEW
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13297 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4049
Mailing Address - Country:US
Mailing Address - Phone:541-914-5863
Mailing Address - Fax:
Practice Address - Street 1:7707 220TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5914
Practice Address - Country:US
Practice Address - Phone:360-436-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61590278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist