Provider Demographics
NPI:1396088696
Name:SHAULIS, REBEKAH (MA, LLPC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:SHAULIS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 POINT VISTA RD APT 8203
Mailing Address - Street 2:
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7656
Mailing Address - Country:US
Mailing Address - Phone:940-595-2971
Mailing Address - Fax:
Practice Address - Street 1:1021 POINT VISTA RD APT 8203
Practice Address - Street 2:
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7656
Practice Address - Country:US
Practice Address - Phone:940-595-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional