Provider Demographics
NPI:1609441914
Name:WEDEL, REBECCA MAYFIELD (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAYFIELD
Last Name:WEDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MAYFIELD
Other - Last Name:WEDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:919 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8424
Mailing Address - Country:US
Mailing Address - Phone:949-677-4569
Mailing Address - Fax:
Practice Address - Street 1:919 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8424
Practice Address - Country:US
Practice Address - Phone:949-677-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical