Provider Demographics
NPI:1053498329
Name:SPILLER, LAURA COLLAZOS (PH D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:COLLAZOS
Last Name:SPILLER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1842
Mailing Address - Country:US
Mailing Address - Phone:940-567-1046
Mailing Address - Fax:
Practice Address - Street 1:1113 VINE ST
Practice Address - Street 2:SUITE 221
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-1042
Practice Address - Country:US
Practice Address - Phone:940-567-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX231956OtherCOMPSYCH
TX0056JBOtherBLUE CROSS BLUE SHIELD TX
TX00195CMedicare ID - Type Unspecified
TX473011OtherVALUE OPTIONS
TX854780OtherCLARENDON CHIP
TX9020730OtherCIGNA HEALTH CARE