Active NPI
Rebecca Lynn Sidwell-Douglas
- Counselor
- Chesterfield, MO
National Provider Identifier
1386844546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2005028054
- Practice address
- 14377 Woodlake Dr
Suite 308
Chesterfield, MO 63017-5735 - Phone
- (314) 576-6493
- Fax
- (314) 576-7319
- NPI assigned
- Jul 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2005028054 | MO | Primary |
Addresses
Primary practice location
14377 Woodlake Dr
Suite 308
Chesterfield, MO 63017-5735
Mailing address
14377 Woodlake Dr
Suite 308
Chesterfield, MO 63017-5735
Phone (314) 576-6493
Other names 1
- Ms. Rebecca Lynn Sidwell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Saint Louis, MO 63195
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005028054 | MO | MD | Counselor |
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.
-
- Multi-Specialty Clinic/Center
- Fenton, MO
- NPI 1700966207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187740800000",
"number": "1386844546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14377 WOODLAKE DR",
"address_2": "SUITE 308",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630175735",
"telephone_number": "314-576-6493",
"fax_number": "314-576-7319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14377 WOODLAKE DR",
"address_2": "SUITE 308",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630175735",
"telephone_number": "314-576-6493",
"fax_number": "314-576-7319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDWELL-DOUGLAS",
"first_name": "REBECCA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-24",
"last_updated": "2007-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MO",
"license": "2005028054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "REBECCA",
"last_name": "SIDWELL",
"middle_name": "LYNN",
"prefix": "MS.",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Chesterfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.