MEDICARE: MRS. REBECKA HONARDAR

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	101Y00000X	Counselor	67292	TX
2	101YM0800X	Mental Health Counselor	67292	TX

General Provider Information

NPI Number	:	1760811939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECKA HONARDAR

Provider Business Mailing Address
First Line	:	12733 CEDAR HOLLOW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4381
Country	:	US
Telephone Number	:	972-898-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 N CENTRAL EXPY
Second Line	:	SUITE #335
City	:	DALLAS
State	:	TX
Zip	:	75231-8600
Country	:	US
Telephone Number	:	214-265-6051
Fax Number	:

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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