Provider Demographics
NPI:1730765553
Name:PEREZ, REBECCA DENISE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DENISE
Last Name:PEREZ
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 1:8314 BRAESDALE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1228
Mailing Address - Country:US
Mailing Address - Phone:713-240-6320
Mailing Address - Fax:
Practice Address - Street 1:800 BONAVENTURE WAY STE 122
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8005
Practice Address - Country:US
Practice Address - Phone:346-440-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional