Doctor Name: | REBA RICE-PORTWOOD |
NPI Number: | 1013393172 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2015006046 |
Business Practice Address: | 3633 Marietta Dr Ste C Florissant, MO - 630333208 |
Business Phone Number: | 3148315433 |
Business Fax Number: | |
Mailing Address: | 3633 Marietta Dr Ste C, FLORISSANT |
State: | MO |
Postal Code: | 630333208 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/30/2015 |
NPI Last Update Date: | 07/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2015006046 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |