Provider Demographics
NPI:1992938401
Name:CHRISTIAN, REBECCA MARIE (MA, LPC-S, LCDC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MA, LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 E 53RD ST
Mailing Address - Street 2:#1125
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4850
Mailing Address - Country:US
Mailing Address - Phone:254-537-2838
Mailing Address - Fax:
Practice Address - Street 1:4230 E 53RD ST
Practice Address - Street 2:#1125
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-4850
Practice Address - Country:US
Practice Address - Phone:254-537-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
TX17588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)