Organization
REBIRTH COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CRYSTAL DUDLEY LPC (OWNER)
(469) 608-0295
Entity
Organization
Contact information
Practice address
1100 STONE RD STE 103, KILGORE, TX 75662-5494
(466) 608-0295
Mailing address
1100 STONE RD STE 103, KILGORE, TX 75662-5494
(466) 608-0295
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3921009-01
—
TX
Enumeration date
04/22/2019
Last updated
02/04/2020
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