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NPI Code Detail

MEDICARE: MISS ROBIN DENISE VICKERY LPC

MEDICARE: MISS ROBIN DENISE VICKERY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2001020523MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1431116734OTHEREAP INTERFACE
2763085OTHERHEALTHLINK HMO
311621287OTHERCAQH
49875OTHEREAP FEI BEHAVIORAL HEALTH
5152958OTHERBLUE CROSS BLUE SHIELD
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7431116734OTHERVALUE OPTIONS

General Provider Information

NPI Number : 1083638506
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ROBIN DENISE VICKERY LPC
Provider Business Mailing Address
First Line : PO BOX 280
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63902-0280
Country : US
Telephone Number : 573-686-1200
Fax Number : 573-686-1029
Provider Business Practice Location Address
First Line : 3001 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8685
Country : US
Telephone Number : 573-686-1200
Fax Number : 573-686-1029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 01/21/2009

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Directions to “ MISS ROBIN DENISE VICKERY LPC” Practice Location

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