Provider Demographics
NPI:1689435182
Name:RENFROW, REBECCA ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:RENFROW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FUNTIER LN
Mailing Address - Street 2:
Mailing Address - City:HIDE A WAY
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5049
Mailing Address - Country:US
Mailing Address - Phone:832-316-3882
Mailing Address - Fax:
Practice Address - Street 1:1828 ESE LOOP323 STE 306
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8314
Practice Address - Country:US
Practice Address - Phone:903-952-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health