Provider Demographics
NPI:1851960447
Name:WILLIS, REBEKAH SHEA (MS, LPC, CRC, PMH-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:SHEA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MS, LPC, CRC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 ISLAND BYU
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2659
Mailing Address - Country:US
Mailing Address - Phone:469-693-9955
Mailing Address - Fax:
Practice Address - Street 1:305 W WOODARD ST STE 205
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3136
Practice Address - Country:US
Practice Address - Phone:469-403-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health