Provider Demographics
NPI:1043598329
Name:SISTRUNK, REBECCA LEIGH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEIGH
Last Name:SISTRUNK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 NEWCOMB ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-1706
Mailing Address - Country:US
Mailing Address - Phone:806-632-3278
Mailing Address - Fax:
Practice Address - Street 1:5811 86TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3601
Practice Address - Country:US
Practice Address - Phone:806-632-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional