Provider Demographics
NPI:1699982504
Name:YEARWOOD, VICKIE RHEA (MS, LPC)
Entity type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:RHEA
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 W NICKLAS AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6919
Mailing Address - Country:US
Mailing Address - Phone:405-414-0412
Mailing Address - Fax:
Practice Address - Street 1:1209 SOVEREIGN ROW
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1824
Practice Address - Country:US
Practice Address - Phone:405-942-5570
Practice Address - Fax:405-942-5603
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health