Provider Demographics
NPI:1689038481
Name:WECHTER, RENA
Entity Type:Individual
Prefix:MRS
First Name:RENA
Middle Name:
Last Name:WECHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 GRAY WOLF TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2615
Mailing Address - Country:US
Mailing Address - Phone:214-914-6691
Mailing Address - Fax:
Practice Address - Street 1:6230 GRAY WOLF TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2615
Practice Address - Country:US
Practice Address - Phone:214-914-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30510103TS0200X
TX11557103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool