Provider Demographics
NPI:1619239316
Name:ROTH, REBECCA ANN (LMFTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 REDMOND RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1652
Mailing Address - Country:US
Mailing Address - Phone:512-301-2133
Mailing Address - Fax:
Practice Address - Street 1:10600 REDMOND RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1652
Practice Address - Country:US
Practice Address - Phone:512-301-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist