Healthcare Provider Details

I. General information

NPI: 1588793442
Provider Name (Legal Business Name): JOY PHELPS VROONLAND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 87TH ST
LUBBOCK TX
79424-4715
US

IV. Provider business mailing address

PO BOX 504
WOLFFORTH TX
79382-0504
US

V. Phone/Fax

Practice location:
  • Phone: 469-438-5359
  • Fax:
Mailing address:
  • Phone: 469-438-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: