Provider Demographics
NPI:1407645666
Name:ETTER, VICTORIA GRACE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:ETTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 PEBBLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5623
Mailing Address - Country:US
Mailing Address - Phone:720-808-7400
Mailing Address - Fax:
Practice Address - Street 1:651 S MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7054
Practice Address - Country:US
Practice Address - Phone:214-473-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-81046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst