Provider Demographics
NPI:1174770663
Name:TOWNSEND, REBECCA GAYLE (SR LPE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GAYLE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:SR LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0008
Mailing Address - Country:US
Mailing Address - Phone:931-551-4640
Mailing Address - Fax:931-551-4641
Practice Address - Street 1:116 N 2ND ST
Practice Address - Street 2:SUITE B11
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3478
Practice Address - Country:US
Practice Address - Phone:931-551-4640
Practice Address - Fax:931-551-4641
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520228Medicaid