Healthcare Provider Details

I. General information

NPI: 1730224262
Provider Name (Legal Business Name): REDA G RASCO PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 KEMP BLVD
WICHITA FALLS TX
76308-1017
US

IV. Provider business mailing address

4722 TAFT BLVD STE 2
WICHITA FALLS TX
76308-4800
US

V. Phone/Fax

Practice location:
  • Phone: 940-691-1899
  • Fax: 940-691-3423
Mailing address:
  • Phone: 940-691-1899
  • Fax: 940-691-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34999
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number19361
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: