Provider Demographics
NPI:1629452057
Name:MATA, REBECA (MED, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 SAGEBRUSH DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2739
Mailing Address - Country:US
Mailing Address - Phone:682-465-2442
Mailing Address - Fax:
Practice Address - Street 1:2605 SAGEBRUSH DR STE 206
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2739
Practice Address - Country:US
Practice Address - Phone:682-465-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64943101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional