Provider Demographics
NPI:1487968996
Name:RAND, REBECCA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:RAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2886 E FERN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6602
Mailing Address - Country:US
Mailing Address - Phone:208-912-6621
Mailing Address - Fax:
Practice Address - Street 1:136 S ACADEMY AVE STE C
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6541
Practice Address - Country:US
Practice Address - Phone:208-912-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 12296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional