Provider Demographics
NPI:1669996104
Name:FONVILLE, REBECCA FAYE (PSYD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:FAYE
Last Name:FONVILLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 BELLEFONTE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6322
Mailing Address - Country:US
Mailing Address - Phone:316-212-2770
Mailing Address - Fax:
Practice Address - Street 1:12801 N CENTRAL EXPY STE 1730
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:773-809-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist