Provider Demographics
NPI:1003087131
Name:VANCHURA, DARLENE ELLA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:ELLA
Last Name:VANCHURA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1716
Mailing Address - Country:US
Mailing Address - Phone:817-371-4312
Mailing Address - Fax:
Practice Address - Street 1:5751 KROGER DR
Practice Address - Street 2:SUITE 235
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5532
Practice Address - Country:US
Practice Address - Phone:817-371-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional