Provider Demographics
NPI:1720274319
Name:EASLEY, REBECCA S (MS,LPC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:S
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 CROWN BRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2486
Mailing Address - Country:US
Mailing Address - Phone:832-816-7564
Mailing Address - Fax:210-877-6227
Practice Address - Street 1:1407 CROWN BRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-2486
Practice Address - Country:US
Practice Address - Phone:832-816-7564
Practice Address - Fax:210-877-6227
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional