Healthcare Provider Details

I. General information

NPI: 1265750020
Provider Name (Legal Business Name): REBEKAH RUTH PENDER PH.D., LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 BANDERA RD
SAN ANTONIO TX
78228-5524
US

IV. Provider business mailing address

11300 EXPO BLVD APT. 2218
SAN ANTONIO TX
78230-1005
US

V. Phone/Fax

Practice location:
  • Phone: 210-431-6466
  • Fax: 210-431-6470
Mailing address:
  • Phone: 210-557-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: