Healthcare Provider Details

I. General information

NPI: 1356646848
Provider Name (Legal Business Name): REBEKAH PAIGE TRAVIS PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-0102
  • Fax: 214-648-1208
Mailing address:
  • Phone: 214-648-0102
  • Fax: 214-648-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36977
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: