Healthcare Provider Details

I. General information

NPI: 1306375399
Provider Name (Legal Business Name): VICKI DEUMECE NUNEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 CLEAR CREEK RD
KILLEEN TX
76549-4400
US

IV. Provider business mailing address

14138 HWY 195
KILLEEN TX
76542-4850
US

V. Phone/Fax

Practice location:
  • Phone: 719-431-0971
  • Fax:
Mailing address:
  • Phone: 254-519-1144
  • Fax: 254-549-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108425
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: