| Doctor Name: | DR. LAURA COLLAZOS SPILLER |
| NPI Number: | 1053498329 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH. D. |
| License Number: | 31563 |
| Business Practice Address: | 617 3rd St Graham, TX - 764503101 |
| Business Phone Number: | 9405671046 |
| Business Fax Number: | |
| Mailing Address: | 322 W Live Oak St, JACKSBORO |
| State: | TX |
| Postal Code: | 764581749 |
| Phone Number: | 9405671046 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 31563 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |