Provider Demographics
NPI:1730224262
Name:RASCO, REDA G (PSY D)
Entity type:Individual
Prefix:DR
First Name:REDA
Middle Name:G
Last Name:RASCO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 TAFT BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4800
Mailing Address - Country:US
Mailing Address - Phone:940-691-1899
Mailing Address - Fax:940-691-3423
Practice Address - Street 1:2934 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1017
Practice Address - Country:US
Practice Address - Phone:940-691-1899
Practice Address - Fax:940-691-3423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34999103TC0700X
TX19361101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84576LOtherBLUE CROSS ID NUMBER
TX171788601Medicaid