Healthcare Provider Details

I. General information

NPI: 1265353080
Provider Name (Legal Business Name): VICVERA BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10303 20TH ST E APT H203
EDGEWOOD WA
98372-1021
US

IV. Provider business mailing address

10303 20TH ST E APT H203
EDGEWOOD WA
98372-1021
US

V. Phone/Fax

Practice location:
  • Phone: 862-588-1026
  • Fax:
Mailing address:
  • Phone: 862-588-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHUKWUDI OKOLIE
Title or Position: CEO
Credential:
Phone: 862-588-1026