MEDICARE: LORI ANN VICKERS LMFT

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	106H00000X	Marriage & Family Therapist	MFC52384	CA

General Provider Information

NPI Number	:	1710221965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANN VICKERS LMFT

Provider Business Mailing Address
First Line	:	28991 OLD TOWN FRONT ST STE 102
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-2858
Country	:	US
Telephone Number	:	951-264-1226
Fax Number	:	951-308-1515

Provider Business Practice Location Address
First Line	:	28991 OLD TOWN FRONT ST STE 102
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-2858
Country	:	US
Telephone Number	:	951-264-1226
Fax Number	:	951-308-1515

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

Provider Enumeration Date	:	11/11/2012
Last Update Date	:	09/20/2019

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