Provider Demographics
NPI:1922626571
Name:DURHAM, REBECCA KAY
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:DURHAM
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 1:1220 N ALMA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4624
Mailing Address - Country:US
Mailing Address - Phone:469-730-0925
Mailing Address - Fax:972-497-2012
Practice Address - Street 1:1220 N ALMA DR STE 110
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4624
Practice Address - Country:US
Practice Address - Phone:469-730-0925
Practice Address - Fax:972-497-2012
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3474103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst