Provider Demographics
NPI:1285773184
Name:KRAATZ, REBECCA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:KRAATZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:KRAATZ P.L.L.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:118 SABINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1454
Mailing Address - Country:US
Mailing Address - Phone:361-643-6213
Mailing Address - Fax:361-643-1263
Practice Address - Street 1:118 SABINE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1454
Practice Address - Country:US
Practice Address - Phone:361-643-6213
Practice Address - Fax:361-643-1263
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33490103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33490OtherPROVISIONAL LICENSE
51382OtherNATL. REGISTER PSYCHOLOGY