Provider Demographics
NPI:1912283987
Name:SORRELLS, REBECCA S (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:S
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-6205
Mailing Address - Country:US
Mailing Address - Phone:432-582-2444
Mailing Address - Fax:432-582-2449
Practice Address - Street 1:2458 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4236
Practice Address - Country:US
Practice Address - Phone:432-582-2444
Practice Address - Fax:432-582-2449
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional