| Robin K Vickery Lcsw Llc | |
|
497 Sw Century Dr Ste 102 Bend OR 97702-1167 | |
| (541) 640-2101 | |
| (541) 797-6898 |
| Full Name | Robin K Vickery Lcsw Llc |
|---|---|
| Speciality | Counselor |
| Location | 497 Sw Century Dr Ste 102, Bend, Oregon |
| Authorized Official Name and Position | Robin K Vickery (OWNER) |
| Authorized Official Contact | 5413896427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robin K Vickery Lcsw Llc 497 Sw Century Dr Ste 102 Bend OR 97702-1167 Ph: (541) 640-2101 | Robin K Vickery Lcsw Llc 497 Sw Century Dr Ste 102 Bend OR 97702-1167 Ph: (541) 640-2101 |
| NPI Number | 1942824131 |
|---|---|
| Provider Enumeration Date | 06/03/2020 |
| Last Update Date | 06/03/2020 |
| Certification Date | 06/03/2020 |
| Medicare PECOS PAC ID | 0244655231 |
|---|---|
| Medicare Enrollment ID | O20200807002120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942824131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robin K Vickery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861684789 PECOS PAC ID: 9133214448 Enrollment ID: I20071002000359 |
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