Provider Demographics
NPI:1972979847
Name:REBECCA SOUTHARD, LPC
Entity type:Organization
Organization Name:REBECCA SOUTHARD, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:817-988-8581
Mailing Address - Street 1:921 HARWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-2310
Mailing Address - Country:US
Mailing Address - Phone:817-988-8581
Mailing Address - Fax:
Practice Address - Street 1:8827 HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-7716
Practice Address - Country:US
Practice Address - Phone:817-988-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63430251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health