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General NPI Number Information
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NPI Number | 1457606766
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Entity Type | Individual
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Provider Name | REBEKAH MCNULTY LICSW
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 145 W TRAVIS ST STE 104
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City | LA GRANGE
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State | TX
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Zip | 78945-2620
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Country | US
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Telephone | 253-780-7061
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Fax |
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Provider Business Mailing Address
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Address Line | 543 S MADISON ST
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City | LA GRANGE
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State | TX
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Zip | 78945-3241
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Country | US
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Telephone | 253-780-7061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60014198
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105413
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License Number State | TX
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