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General NPI Number Information
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NPI Number | 1407265176
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Entity Type | Organization
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Legal Business Name | VICKI LUMLEY, PH.D., LLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 724 SOUTH CENTRAL AVE. SUITE 101
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City | MEDFORD
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State | OR
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Zip | 97501-7851
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Country | US
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Telephone | 206-327-4854
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Fax | 541-843-2832
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Provider Business Mailing Address
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Address Line | 295 WELLS FARGO DR
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9421
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Country | US
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Telephone | 206-327-4854
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Fax | 541-843-2832
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Authorized Official
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Title or Position | OWNER
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Name | VICKI A LUMLEY
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Credential | PH.D.
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Telephone | 253-549-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 60310066
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License Number State | WA
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