Provider Demographics
NPI:1730621012
Name:JOHNSON, REBECCA (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 KIRBY DR
Mailing Address - Street 2:SUITE 925
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3905
Mailing Address - Country:US
Mailing Address - Phone:713-527-8823
Mailing Address - Fax:713-527-4455
Practice Address - Street 1:3730 KIRBY DR
Practice Address - Street 2:SUITE 925
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3905
Practice Address - Country:US
Practice Address - Phone:713-527-8823
Practice Address - Fax:713-527-4455
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical