Provider Demographics
NPI:1063889061
Name:MCKIEL, VICKI L (LPC)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:MCKIEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:AMBROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:820 PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1566
Mailing Address - Country:US
Mailing Address - Phone:573-883-7407
Mailing Address - Fax:573-863-7537
Practice Address - Street 1:820 PARK DRIVE
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1566
Practice Address - Country:US
Practice Address - Phone:573-883-7407
Practice Address - Fax:573-863-7537
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional