Individual
REBEKAH WISTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
905 DEVILLE LN, RUSTON, LA 71270-6313
(318) 242-4622
Mailing address
905 DEVILLE LN, RUSTON, LA 71270-6313
(318) 242-4622
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2366
LA
Other
Enumeration date
07/13/2015
Last updated
07/13/2015
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