Provider Demographics
NPI:1679318794
Name:KNOBLOCK, REBECCA NAGEL (MA, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:NAGEL
Last Name:KNOBLOCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:EMILY
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 S SHOSHONE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2514
Mailing Address - Country:US
Mailing Address - Phone:303-709-4750
Mailing Address - Fax:
Practice Address - Street 1:760 S SHOSHONE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-2514
Practice Address - Country:US
Practice Address - Phone:303-709-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional