Provider Demographics
NPI:1669793329
Name:HARRIS, REBEKAH L (PHD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:L
Last Name:HARRIS
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 1:15209 S PADRE ISLAND DR
Mailing Address - Street 2:807
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6267
Mailing Address - Country:US
Mailing Address - Phone:254-744-3191
Mailing Address - Fax:
Practice Address - Street 1:5350 S STAPLES ST
Practice Address - Street 2:200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4682
Practice Address - Country:US
Practice Address - Phone:361-992-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34722103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88248AOtherBCBS TX
TX281875901Medicaid
TX88248AOtherBCBS TX