Provider Demographics
NPI:1821006305
Name:POWELL-SLAYTON, REBECCA (LPC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:POWELL-SLAYTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:POWELL
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 W CANTU RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3056
Mailing Address - Country:US
Mailing Address - Phone:830-774-4447
Mailing Address - Fax:830-774-4265
Practice Address - Street 1:501 W CANTU RD
Practice Address - Street 2:SUITE 400
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3056
Practice Address - Country:US
Practice Address - Phone:830-774-4447
Practice Address - Fax:830-774-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095504901Medicaid