Healthcare Provider Details

I. General information

NPI: 1699782532
Provider Name (Legal Business Name): VIKI MARKHAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 WOODMILL LN
FELTON CA
95018-8711
US

IV. Provider business mailing address

59 WOODMILL LN
FELTON CA
95018-8711
US

V. Phone/Fax

Practice location:
  • Phone: 831-335-7270
  • Fax: 831-335-7270
Mailing address:
  • Phone: 831-335-7270
  • Fax: 831-335-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT20219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: