Provider Demographics
NPI:1306106620
Name:MCCONNELL, REBECCA (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5257
Mailing Address - Country:US
Mailing Address - Phone:512-608-2563
Mailing Address - Fax:
Practice Address - Street 1:5701 S. MOPAC EXPY
Practice Address - Street 2:#1412
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-608-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional