Provider Demographics
NPI:1154470524
Name:VOGEL, MARTHA CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:CHRISTINE
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 1:4315 GUADALUPE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3644
Mailing Address - Country:US
Mailing Address - Phone:512-473-2793
Mailing Address - Fax:
Practice Address - Street 1:4315 GUADALUPE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3644
Practice Address - Country:US
Practice Address - Phone:512-473-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32565103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077MXOtherBCBS OF TEXAS
TX0077MXOtherBCBS OF TEXAS