Provider Demographics
NPI:1306061650
Name:MOYLE, VICKY FRANKFOURTH (LPC)
Entity type:Individual
Prefix:MS
First Name:VICKY
Middle Name:FRANKFOURTH
Last Name:MOYLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6328
Mailing Address - Country:US
Mailing Address - Phone:970-261-2594
Mailing Address - Fax:
Practice Address - Street 1:2708 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-4031
Practice Address - Country:US
Practice Address - Phone:970-243-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4036101YP2500X
WALH00011001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11691959OtherCAQH PROVIDER