Provider Demographics
NPI:1710406749
Name:WAECHTER, REBECCA MERRE (MA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MERRE
Last Name:WAECHTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MERRE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 E TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1234
Mailing Address - Country:US
Mailing Address - Phone:580-379-6850
Mailing Address - Fax:580-379-6859
Practice Address - Street 1:1200 E TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1234
Practice Address - Country:US
Practice Address - Phone:580-379-6850
Practice Address - Fax:580-379-6859
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor