Provider Demographics
NPI:1447964002
Name:PAULI, REBEKAH ROSE (LCPC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ROSE
Last Name:PAULI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:
Other - Last Name:PAULI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:416 W MENDENHALL ST STE D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3477
Mailing Address - Country:US
Mailing Address - Phone:406-930-1154
Mailing Address - Fax:
Practice Address - Street 1:416 W MENDENHALL ST STE D
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3477
Practice Address - Country:US
Practice Address - Phone:406-930-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-62889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional