Provider Demographics
NPI:1609586189
Name:RICHARD, REBEKAH D (LMSW)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:D
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 E TWOHIG AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6433
Mailing Address - Country:US
Mailing Address - Phone:325-944-2561
Mailing Address - Fax:
Practice Address - Street 1:805 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252-7690
Practice Address - Country:US
Practice Address - Phone:575-249-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2023-04-05
Deactivation Date:2022-12-06
Deactivation Code:
Reactivation Date:2022-12-23
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCTB-2022-0830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11222022OtherCBT