Basic Information
| Provider Information | |||||||||
| NPI: | 1871963181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REBHAN | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1335 N MILL ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605632261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306468000 | ||||||||
| FaxNumber: | 6306468007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1335 N MILL ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605632261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306468000 | ||||||||
| FaxNumber: | 6306468007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180007655 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.