Healthcare Provider Details

I. General information

NPI: 1275438590
Provider Name (Legal Business Name): REBECCA CHEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 STONE MYERS PKWY STE 100
GRAPEVINE TX
76051-4783
US

IV. Provider business mailing address

2733 PRESTONDALE DR
HURST TX
76054-2337
US

V. Phone/Fax

Practice location:
  • Phone: 817-906-1111
  • Fax:
Mailing address:
  • Phone: 682-414-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103443
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: