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General NPI Number Information
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NPI Number | 1154931616
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Entity Type | Individual
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Provider Name | DAVID VICK LPC
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Gender | Male
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Dates
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Enumeration Date | 08/08/2020
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Last Update Date | 09/10/2023
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Provider Practice Location Address
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Address Line | 440 JOHNSON RD STE C
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City | KELLER
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State | TX
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Zip | 76248-3465
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Country | US
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Telephone | 817-431-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 6057 HILLTOP DR
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City | WATAUGA
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State | TX
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Zip | 76148-1359
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Country | US
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Telephone | 817-929-5599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 1507399
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 78424
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License Number State | TX
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