Healthcare Provider Details

I. General information

NPI: 1346906674
Provider Name (Legal Business Name): REBECCA CHRISTINE GATES LPC, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 HILLWOOD PKWY STE 140
FORT WORTH TX
76177-1532
US

IV. Provider business mailing address

1104 LAKIN RD
FORT WORTH TX
76177-1827
US

V. Phone/Fax

Practice location:
  • Phone: 682-667-4164
  • Fax:
Mailing address:
  • Phone: 682-667-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71627
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number37168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: