Healthcare Provider Details

I. General information

NPI: 1326185562
Provider Name (Legal Business Name): VICKY LYNN SPEAR M.A. CADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 SW CANYON RD STE 118
PORTLAND OR
97225-3456
US

IV. Provider business mailing address

20333 STATE HIGHWAY 249 STE 200
HOUSTON TX
77070-2613
US

V. Phone/Fax

Practice location:
  • Phone: 503-922-3360
  • Fax: 971-352-4229
Mailing address:
  • Phone: 503-922-3360
  • Fax: 971-352-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR10423
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number05-03-64U
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: