Provider Demographics
NPI:1952092926
Name:MOUTRAY, REBECCA (MED,LPC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MOUTRAY
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 COUNTY ROAD 499
Mailing Address - Street 2:
Mailing Address - City:NORMANGEE
Mailing Address - State:TX
Mailing Address - Zip Code:77871-3584
Mailing Address - Country:US
Mailing Address - Phone:210-584-3982
Mailing Address - Fax:
Practice Address - Street 1:12304 COUNTY ROAD 499
Practice Address - Street 2:
Practice Address - City:NORMANGEE
Practice Address - State:TX
Practice Address - Zip Code:77871-3584
Practice Address - Country:US
Practice Address - Phone:210-584-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional