Provider Demographics
NPI:1487768255
Name:WILLS, REBECCA L (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:WILLS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-2113
Mailing Address - Country:US
Mailing Address - Phone:856-912-4038
Mailing Address - Fax:
Practice Address - Street 1:608 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-2113
Practice Address - Country:US
Practice Address - Phone:856-912-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00322100101YP2500X
PAPC012321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ781952000OtherMAGELLAN BEHAVIORAL MIS