Provider Demographics
NPI:1285469221
Name:VICKERS, MACI LAINE (RBT)
Entity type:Individual
Prefix:
First Name:MACI
Middle Name:LAINE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3504
Mailing Address - Country:US
Mailing Address - Phone:918-216-0242
Mailing Address - Fax:405-757-0727
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3504
Practice Address - Country:US
Practice Address - Phone:918-216-0242
Practice Address - Fax:405-757-0727
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-24-376104106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician