Provider Demographics
NPI:1548614712
Name:DAVIS, REBEKAH LAUREN (LMSW)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LAUREN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:LAUREN
Other - Last Name:PIDCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10616 MELLOW MDWS
Mailing Address - Street 2:#8A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1251
Mailing Address - Country:US
Mailing Address - Phone:512-761-5166
Mailing Address - Fax:
Practice Address - Street 1:10616 MELLOW MDWS
Practice Address - Street 2:#8A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1251
Practice Address - Country:US
Practice Address - Phone:512-761-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60661171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator