Provider Demographics
NPI:1689401218
Name:WEINHEIMER, REBEKAH ANNE
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANNE
Last Name:WEINHEIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631A CHALK BUTTE
Mailing Address - Street 2:
Mailing Address - City:OUTLOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59252-9724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 N 19TH AVE STE 2C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6069
Practice Address - Country:US
Practice Address - Phone:406-812-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-72699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health