Healthcare Provider Details

I. General information

NPI: 1659099927
Provider Name (Legal Business Name): VICKEY GIAP THISTLETHWAITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CENTERPOINTE DRIVE SUITE 400
LAKE OSWEGO OR
97035-8661
US

IV. Provider business mailing address

5 CENTERPOINTE DRIVE SUITE 400
LAKE OSWEGO OR
97035-8661
US

V. Phone/Fax

Practice location:
  • Phone: 971-724-8442
  • Fax: 971-497-0579
Mailing address:
  • Phone: 971-724-8442
  • Fax: 971-497-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61352033
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61565713
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61629181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: