Provider Demographics
NPI:1588793442
Name:VROONLAND, JOY PHELPS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:PHELPS
Last Name:VROONLAND
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:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-0504
Mailing Address - Country:US
Mailing Address - Phone:469-438-5359
Mailing Address - Fax:
Practice Address - Street 1:6902 87TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4715
Practice Address - Country:US
Practice Address - Phone:469-438-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26894103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029873901Medicaid
TX029873901Medicaid
TX20-1332835OtherTAX ID NUMBER