Provider Demographics
NPI:1154030799
Name:FAHEY, REBEKAH L (MA, BCBA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:L
Last Name:FAHEY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SOUTHEASTERN TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-8004
Mailing Address - Country:US
Mailing Address - Phone:903-235-1318
Mailing Address - Fax:
Practice Address - Street 1:15930 S GREAT OAKS DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5800
Practice Address - Country:US
Practice Address - Phone:512-460-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst