Provider Demographics
NPI:1679627277
Name:JEFFERS, REBECCA A (LPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 OLD MILL RUN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7025
Mailing Address - Country:US
Mailing Address - Phone:817-219-7913
Mailing Address - Fax:
Practice Address - Street 1:4200 S HULEN ST STE 662
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4997
Practice Address - Country:US
Practice Address - Phone:817-219-7913
Practice Address - Fax:817-886-8616
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103300OtherUNITED HEALTHCARE
TX4169LCOtherBLUE CROSS BLUE SHIELD
TX490819OtherVALUE OPTIONS
TX028292301Medicaid