1609586189 NPI number — REBEKAH D RICHARD LMSW

Table of content: REBEKAH D RICHARD LMSW (NPI 1609586189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609586189 NPI number — REBEKAH D RICHARD LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARD
Provider First Name:
REBEKAH
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609586189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/06/2022
NPI Reactivation Date:
12/23/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 E TWOHIG AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANGELO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76903-6433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-944-2561
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 W KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88252-7690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-249-2561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CTB-2022-0830 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11222022 . This is a "CBT" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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