MEDICARE: REBECCA JEAN MARSH PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	31000	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588695498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JEAN MARSH PSYD

Provider Business Mailing Address
First Line	:	5320 E CENTRAL TEXAS EXPY
Second Line	:	STE 105
City	:	KILLEEN
State	:	TX
Zip	:	76543-5516
Country	:	US
Telephone Number	:	254-519-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 S CLEAR CREEK RD
Second Line	:	SUTIE 103
City	:	KILLEEN
State	:	TX
Zip	:	76549-4984
Country	:	US
Telephone Number	:	254-519-1900
Fax Number	:	254-519-1980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/02/2021

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