Healthcare Provider Details

I. General information

NPI: 1831053685
Provider Name (Legal Business Name): VICKI LYNN WHATLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 HILL ST
BASTROP TX
78602-3949
US

IV. Provider business mailing address

155 COLLINS DR UNIT 13101
BASTROP TX
78602-0379
US

V. Phone/Fax

Practice location:
  • Phone: 512-718-4509
  • Fax:
Mailing address:
  • Phone: 512-718-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: