Provider Demographics
NPI:1588695498
Name:MARSH, REBECCA JEAN (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:MARSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:STE 105
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5516
Mailing Address - Country:US
Mailing Address - Phone:254-519-1900
Mailing Address - Fax:
Practice Address - Street 1:2300 S CLEAR CREEK RD
Practice Address - Street 2:SUTIE 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4984
Practice Address - Country:US
Practice Address - Phone:254-519-1900
Practice Address - Fax:254-519-1980
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030526003Medicaid
TX8K8788Medicare PIN