MEDICARE: MRS. VICTORIA ANNA WHATLEY LPC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	10572	OK

General Provider Information

NPI Number	:	1093065674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA ANNA WHATLEY LPC-S

Provider Business Mailing Address
First Line	:	917 CEDAR LAKE BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7813
Country	:	US
Telephone Number	:	405-655-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 CEDAR LAKE BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7813
Country	:	US
Telephone Number	:	405-655-0065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	05/09/2025

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