Provider Demographics
NPI:1659438836
Name:STIDHAM, REBECCA CLAIR (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIR
Last Name:STIDHAM
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 1:6750 WEST LOOP S
Mailing Address - Street 2:SUITE 710
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4103
Mailing Address - Country:US
Mailing Address - Phone:713-666-0710
Mailing Address - Fax:713-666-0711
Practice Address - Street 1:6750 WEST LOOP S
Practice Address - Street 2:SUITE 710
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4103
Practice Address - Country:US
Practice Address - Phone:713-666-0710
Practice Address - Fax:713-666-0711
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical