=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437319225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBECCA B. LAPIDUS, PHD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2008
-----------------------------------------------------
Last Update Date | 01/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 MIRON DR
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-7831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-601-5475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 271464
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75027-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-601-5475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. REBECCA B LAPIDUS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 817-601-5475
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PSY002881
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 37445
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------