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General NPI Number Information
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NPI Number | 1083820070
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Entity Type | Individual
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Provider Name | MARY MARTHA VANCE PHD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/22/2026
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Provider Practice Location Address
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Address Line | 100A W DEAN KEETON ST 1 UNIVERSITY STATION A3500
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City | AUSTIN
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State | TX
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Zip | 78712-1002
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Country | US
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Telephone | 512-475-6938
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Fax | 512-471-8875
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Provider Business Mailing Address
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Address Line | 11651 RIVER OAKS TRL
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City | AUSTIN
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State | TX
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Zip | 78753-2836
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Country | US
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Telephone | 512-585-7317
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32564
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License Number State | TX
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