Provider Demographics
NPI:1104031632
Name:BIRD, REBECCA TAYLOR (LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:TAYLOR
Last Name:BIRD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5589
Mailing Address - Country:US
Mailing Address - Phone:214-529-3964
Mailing Address - Fax:972-497-9537
Practice Address - Street 1:8330 MEADOW RD
Practice Address - Street 2:STE.114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3767
Practice Address - Country:US
Practice Address - Phone:214-529-3964
Practice Address - Fax:214-750-1971
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health