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General NPI Number Information
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NPI Number | 1134552979
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Entity Type | Individual
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Provider Name | REBECCA AUGUSTE SUFFNESS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 205 WILD BASIN RD S #3 SUITE 202
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-246-7225
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Fax | 512-879-9577
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Provider Business Mailing Address
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Address Line | 205 WILD BASIN RD S #3 SUITE 202
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-246-7225
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Fax | 512-879-9577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4830
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 38044
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License Number State | TX
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