Provider Demographics
NPI:1033489398
Name:VANDYKE, PAULA (MA, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 CORPORATE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4096
Mailing Address - Country:US
Mailing Address - Phone:281-940-8745
Mailing Address - Fax:
Practice Address - Street 1:10701 CORPORATE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4096
Practice Address - Country:US
Practice Address - Phone:281-940-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64964101YP2500X
TX201285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist