Provider Demographics
NPI:1851692321
Name:WREN, REBECCA GREATHOUSE (MED, LPCS, LSOTP-S)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:GREATHOUSE
Last Name:WREN
Suffix:
Gender:F
Credentials:MED, LPCS, LSOTP-S
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:HALE
Other - Last Name:GREATHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPCS, LSOTP-S
Mailing Address - Street 1:HC 75 BOX 203
Mailing Address - Street 2:
Mailing Address - City:FORT DAVIS
Mailing Address - State:TX
Mailing Address - Zip Code:79734-5013
Mailing Address - Country:US
Mailing Address - Phone:432-426-9034
Mailing Address - Fax:
Practice Address - Street 1:107 DEER RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT DAVIS
Practice Address - State:TX
Practice Address - Zip Code:79734-2507
Practice Address - Country:US
Practice Address - Phone:432-426-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional