Provider Demographics
NPI:1164767455
Name:STEMSRUD, REBECCA OLIVA (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:OLIVA
Last Name:STEMSRUD
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 1:3726 MARK JASON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-9344
Mailing Address - Country:US
Mailing Address - Phone:915-255-7280
Mailing Address - Fax:
Practice Address - Street 1:3726 MARK JASON DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-9344
Practice Address - Country:US
Practice Address - Phone:915-255-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309476501Medicaid