MEDICARE: VICKI BERK

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	101Y00000X	Counselor	17824	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275619348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI BERK

Provider Business Mailing Address
First Line	:	407 CEDAR LAKE DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-0816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 SPACE PARK DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3469
Country	:	US
Telephone Number	:	713-304-2035
Fax Number	:	281-334-4324

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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Directions to “ VICKI BERK ” Practice Location

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