Provider Demographics
NPI:1982971578
Name:VENGHAUS, MARY K (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:VENGHAUS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:821 W 11TH ST
Mailing Address - Street 2:B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2009
Mailing Address - Country:US
Mailing Address - Phone:512-499-8929
Mailing Address - Fax:
Practice Address - Street 1:821 WEST 11TH STREET
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2212
Practice Address - Country:US
Practice Address - Phone:512-499-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health