Provider Demographics
NPI:1386854529
Name:BACSIK, REBECCA GRAY (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GRAY
Last Name:BACSIK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 LONG CV
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-4960
Mailing Address - Country:US
Mailing Address - Phone:972-414-4753
Mailing Address - Fax:
Practice Address - Street 1:9941 LINGO LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3349
Practice Address - Country:US
Practice Address - Phone:972-502-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist