Provider Demographics
NPI:1366421315
Name:VICKROY, DEBRA ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:VICKROY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13006 PHILADELPHIA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4216
Mailing Address - Country:US
Mailing Address - Phone:562-696-7429
Mailing Address - Fax:562-324-6848
Practice Address - Street 1:13006 PHILADELPHIA ST STE 601
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601
Practice Address - Country:US
Practice Address - Phone:562-696-7429
Practice Address - Fax:562-324-6848
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist