Healthcare Provider Details

I. General information

NPI: 1679342455
Provider Name (Legal Business Name): THADRA R VRUBEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N LILLIAN ST
BARTLETT TX
76511-4534
US

IV. Provider business mailing address

PO BOX 396
BARTLETT TX
76511-0396
US

V. Phone/Fax

Practice location:
  • Phone: 512-496-9709
  • Fax:
Mailing address:
  • Phone: 512-496-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67014
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: