Provider Demographics
NPI:1144746991
Name:BOREN, REBECCA A (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:BOREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:FRANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7670 WOODWAY DR STE 270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1598
Mailing Address - Country:US
Mailing Address - Phone:832-583-7373
Mailing Address - Fax:
Practice Address - Street 1:7670 WOODWAY DR STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1598
Practice Address - Country:US
Practice Address - Phone:832-583-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61227876103TC0700X
PY.61227876103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2220333Medicaid