Provider Demographics
NPI:1447485453
Name:REBECCA C. BURCKHARDT, LPC
Entity type:Organization
Organization Name:REBECCA C. BURCKHARDT, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BURCKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-795-7815
Mailing Address - Street 1:255 SPENCER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2494
Mailing Address - Country:US
Mailing Address - Phone:636-795-7815
Mailing Address - Fax:
Practice Address - Street 1:255 SPENCER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2494
Practice Address - Country:US
Practice Address - Phone:636-795-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 002706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty