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NPI Code Detail

MEDICARE: MRS. REBECCA EVANS LPC-S

MEDICARE: MRS. REBECCA EVANS LPC-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor64790TX

General Provider Information

NPI Number : 1154149797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA EVANS LPC-S
Provider Business Mailing Address
First Line : 1004 ROBLES WAY
Second Line :
City : BURLESON
State : TX
Zip : 76028-2762
Country : US
Telephone Number : 817-307-3528
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLAZA DR STE 307
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4230
Country : US
Telephone Number : 817-232-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2024
Last Update Date : 10/02/2024

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Directions to “ MRS. REBECCA EVANS LPC-S” Practice Location

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