Provider Demographics
NPI:1174680862
Name:RUMANN, IDETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:IDETTE
Middle Name:
Last Name:RUMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 NASA PKWY
Mailing Address - Street 2:SUITE 193
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3039
Mailing Address - Country:US
Mailing Address - Phone:281-435-4788
Mailing Address - Fax:832-415-6403
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1952
Practice Address - Country:US
Practice Address - Phone:281-435-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11961101Y00000X, 103T00000X, 101YM0800X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist