Provider Demographics
NPI:1518165596
Name:WAGNER, REBECCA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DEL BELLO LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3079
Mailing Address - Country:US
Mailing Address - Phone:713-338-1927
Mailing Address - Fax:
Practice Address - Street 1:5601 DEL BELLO LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3079
Practice Address - Country:US
Practice Address - Phone:713-338-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling