Individual provider Active NPI

Rebecca J Welborn, LACA, BSADC,CAPRC II

  • Addiction (Substance Use Disorder) Counselor
  • Greenfield, IN
National Provider Identifier
1104600592
Registry record updated Nov 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
99128120A Issued in IN
Practice address
704 N State St Ste a
Greenfield, IN 46140-3616
Phone
(317) 406-8191
NPI assigned
Aug 24, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X IN
Peer Specialist 175T00000X CAPRC2-5198 IN
Addiction (Substance Use Disorder) Counselor 101YA0400X 99128120A IN Primary

Addresses

Primary practice location

704 N State St Ste a
Greenfield, IN 46140-3616

Mailing address

304 S Jefferson St
Knightstown, IN 46148-1326
Phone (317) 318-4802

Other names 1

  • Becky Welborn Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
99128120AINMDAddiction (Substance Use Disorder) Counselor
CAPRC2-5198INMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Rugged Grace, LLC CurrentSince Sep 5, 2023 Accepting new patients

Locations

704 N State St
Ste A
Greenfield, IN 46140
Phone (317) 316-9925

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731801600000",
    "number": "1104600592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S JEFFERSON ST",
            "city": "KNIGHTSTOWN",
            "state": "IN",
            "postal_code": "461481326",
            "telephone_number": "317-318-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 N STATE ST STE A",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461403616",
            "telephone_number": "317-406-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELBORN",
        "first_name": "REBECCA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "LACA, BSADC,CAPRC II",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-24",
        "last_updated": "2024-11-17",
        "certification_date": "2024-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "IN",
            "license": "CAPRC2-5198",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "99128120A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BECKY",
            "last_name": "WELBORN",
            "credential": "LACA, BSADC,CAPRC II",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenfield, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.