Provider Demographics
NPI:1821282781
Name:VOGEL, LAURA (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1569
Mailing Address - Country:US
Mailing Address - Phone:214-478-6669
Mailing Address - Fax:972-539-8703
Practice Address - Street 1:3861 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1569
Practice Address - Country:US
Practice Address - Phone:214-478-6669
Practice Address - Fax:972-539-8703
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30707103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12308318OtherCAQH PROVIDER ID