Provider Demographics
NPI:1235149519
Name:DAVENPORT, REBECCA C (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 LEDGEROCK RD
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-4211
Mailing Address - Country:US
Mailing Address - Phone:512-801-8353
Mailing Address - Fax:512-494-0788
Practice Address - Street 1:1717 W 6TH ST STE 234
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4776
Practice Address - Country:US
Practice Address - Phone:512-801-8353
Practice Address - Fax:512-494-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health