Rebirth Counseling, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REBIRTH COUNSELING, PLLC

Practice address

1100 Stone Rd Ste 103
Kilgore, TX 75662-5494

Phone

(466) 608-0295

NPI assigned

Apr 22, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Crystal Dudley, LPC

Title

Owner

Phone

(469) 608-0295

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1336702661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 STONE RD STE 103",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756625494",
            "telephone_number": "466-608-0295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 STONE RD STE 103",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756625494",
            "telephone_number": "466-608-0295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBIRTH COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-22",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-608-0295",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3921009-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Kilgore, TX
• Providers in Kilgore, TX by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.