Provider Demographics
NPI:1831842947
Name:FAGGETT, REBECCA SALAZAR (LMFTA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SALAZAR
Last Name:FAGGETT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 ROMA DR APT 110
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4663
Mailing Address - Country:US
Mailing Address - Phone:254-537-3006
Mailing Address - Fax:
Practice Address - Street 1:1701 N COLLINS BLVD STE 235
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3553
Practice Address - Country:US
Practice Address - Phone:972-294-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist