Provider Demographics
NPI:1689701427
Name:HAYHURST, REBECCA BOWERS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:BOWERS
Last Name:HAYHURST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 TENISON CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1025
Mailing Address - Country:US
Mailing Address - Phone:512-452-2929
Mailing Address - Fax:512-452-5656
Practice Address - Street 1:3215 STECK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7566
Practice Address - Country:US
Practice Address - Phone:512-452-2929
Practice Address - Fax:512-452-5656
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20-4380108OtherEIN