Healthcare Provider Details

I. General information

NPI: 1487487773
Provider Name (Legal Business Name): VIKTORIA L MCQUEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MAIN ST STE 500
EVANSVILLE IN
47708-1853
US

IV. Provider business mailing address

PO BOX 33
EVANSVILLE IN
47701-0033
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-8333
  • Fax: 812-402-8331
Mailing address:
  • Phone: 812-402-8333
  • Fax: 812-402-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405915-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number88002874A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: