Healthcare Provider Details

I. General information

NPI: 1831842947
Provider Name (Legal Business Name): REBECCA SALAZAR FAGGETT LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N COLLINS BLVD STE 235
RICHARDSON TX
75080-3553
US

IV. Provider business mailing address

6051 ROMA DR APT 110
SHREVEPORT LA
71105-4663
US

V. Phone/Fax

Practice location:
  • Phone: 972-294-3691
  • Fax:
Mailing address:
  • Phone: 254-537-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number203616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: