Healthcare Provider Details

I. General information

NPI: 1417508169
Provider Name (Legal Business Name): CANVAS COUNSELING AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LAKESIDE BLVD # 145
RICHARDSON TX
75082-4341
US

IV. Provider business mailing address

120 E GRUBB DR UNIT 852751
MESQUITE TX
75185-5130
US

V. Phone/Fax

Practice location:
  • Phone: 214-307-2340
  • Fax:
Mailing address:
  • Phone: 214-307-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: REBECCA DANIELLE HOGG
Title or Position: OWNER & LICENSED PROFESSIONAL COUNS
Credential: MA, LPC, RPT
Phone: 214-307-2340