Provider Demographics
NPI:1194055624
Name:VICKI K STILES LPCC
Entity type:Organization
Organization Name:VICKI K STILES LPCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-387-5165
Mailing Address - Street 1:HC 34 BOX 2GG
Mailing Address - Street 2:
Mailing Address - City:SAPELLO
Mailing Address - State:NM
Mailing Address - Zip Code:87745-9501
Mailing Address - Country:US
Mailing Address - Phone:575-387-5165
Mailing Address - Fax:
Practice Address - Street 1:580 STATE HWY 518
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732
Practice Address - Country:US
Practice Address - Phone:575-387-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0115881251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health