MEDICARE: CHANTEL MARIE VICKS MA

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

General Provider Information

NPI Number	:	1497111876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL MARIE VICKS MA

Provider Business Mailing Address
First Line	:	908 W KRUEGER LN
Second Line	:
City	:	WESTWEGO
State	:	LA
Zip	:	70094-3712
Country	:	US
Telephone Number	:	504-487-0503
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 VETERANS MEMORIAL BLVD
Second Line	:	SUITE 215
City	:	KENNER
State	:	LA
Zip	:	70062-4715
Country	:	US
Telephone Number	:	504-405-5280
Fax Number	:	504-405-5434

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

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	03/08/2026

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Directions to “ CHANTEL MARIE VICKS MA” Practice Location

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