Healthcare Provider Details

I. General information

NPI: 1518165596
Provider Name (Legal Business Name): REBECCA ANN WAGNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LONG CREEK RD
AUSTIN TX
78737-9303
US

IV. Provider business mailing address

20 LONG CREEK RD
AUSTIN TX
78737-9303
US

V. Phone/Fax

Practice location:
  • Phone: 713-338-1927
  • Fax:
Mailing address:
  • Phone: 713-338-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34665
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: