Provider Demographics
NPI:1316097561
Name:MUSIC, VICKI L (PSYD, LCSW)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:MUSIC
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S GLENSTONE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0313
Mailing Address - Country:US
Mailing Address - Phone:417-862-8282
Mailing Address - Fax:417-862-8805
Practice Address - Street 1:1111 S GLENSTONE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0313
Practice Address - Country:US
Practice Address - Phone:417-862-8282
Practice Address - Fax:417-862-8805
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0015951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO182797OtherBCBS PROVIDER NUMBER