Basic Information
| Provider Information | |||||||||
| NPI: | 1578194288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNT | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GRASS | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16448 SE ORCHARD VIEW LN | ||||||||
| Address2: | |||||||||
| City: | DAMASCUS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970896895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039570088 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12901 SE 97TH AVE STE 180 | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970157903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712066337 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2020 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.