Provider Demographics
NPI:1194544817
Name:DOUD, VICKI LYNN (ACMHC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:DOUD
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S 320 E
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-5538
Mailing Address - Country:US
Mailing Address - Phone:425-466-8608
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST STE 2A-1
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1852
Practice Address - Country:US
Practice Address - Phone:425-466-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14024463-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health