Healthcare Provider Details

I. General information

NPI: 1821282781
Provider Name (Legal Business Name): LAURA VOGEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 LONG PRAIRIE RD SUITE 101
FLOWER MOUND TX
75028-1569
US

IV. Provider business mailing address

3861 LONG PRAIRIE RD SUITE 101
FLOWER MOUND TX
75028-1569
US

V. Phone/Fax

Practice location:
  • Phone: 214-478-6669
  • Fax: 972-539-8703
Mailing address:
  • Phone: 214-478-6669
  • Fax: 972-539-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number30707
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: