Provider Demographics
NPI:1144987967
Name:STANLEY, REBECCA JOANNE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOANNE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9989 S STATE HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-4615
Mailing Address - Country:US
Mailing Address - Phone:979-820-1336
Mailing Address - Fax:
Practice Address - Street 1:9989 S STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-4615
Practice Address - Country:US
Practice Address - Phone:979-820-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373188702Medicaid