| The Rebrand Report, Llc | |
|
7912 Gangway Dr Fort Worth TX 76179-1978 | |
| (972) 626-6275 | |
| (469) 722-5862 |
| Full Name | The Rebrand Report, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7912 Gangway Dr, Fort Worth, Texas |
| Authorized Official Name and Position | Johnishau Herring-smith (THERAPIST) |
| Authorized Official Contact | 9726266275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Rebrand Report, Llc 7912 Gangway Dr Fort Worth TX 76179-1978 Ph: (972) 626-6275 | The Rebrand Report, Llc 7912 Gangway Dr Fort Worth TX 76179-1978 Ph: (972) 626-6275 |
| NPI Number | 1619576204 |
|---|---|
| Provider Enumeration Date | 10/23/2020 |
| Last Update Date | 07/09/2026 |
| Certification Date | 07/09/2026 |
| Medicare PECOS PAC ID | 9234549478 |
|---|---|
| Medicare Enrollment ID | O20201029001835 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619576204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Johnishau Leigh Herring |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457958845 PECOS PAC ID: 9638589831 Enrollment ID: I20201028003072 |
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