MEDICARE: REBECCA HERON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	38849	TX

General Provider Information

NPI Number	:	1922727544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HERON PHD

Provider Business Mailing Address
First Line	:	21021 SPRING BROOK PLAZA DR STE 140
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5339
Country	:	US
Telephone Number	:	821-717-7166
Fax Number	:	888-717-2354

Provider Business Practice Location Address
First Line	:	147 BELLA KATY DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6819
Country	:	US
Telephone Number	:	832-717-7166
Fax Number	:	888-717-2354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/25/2022

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Directions to “ REBECCA HERON PHD” Practice Location

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