1255646030 NPI number — VICTORIA MICHELLE TERRILL LCSW

Table of content: VICTORIA MICHELLE TERRILL LCSW (NPI 1255646030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255646030 NPI number — VICTORIA MICHELLE TERRILL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRILL
Provider First Name:
VICTORIA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255646030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1631 FIRETHORNE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-625-3566
Provider Business Mailing Address Fax Number:
805-659-9959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S. WELLS RD., SUITE 200
Provider Second Line Business Practice Location Address:
CLINICAS DEL CAMINO REAL, INCORPORATED
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-659-1740
Provider Business Practice Location Address Fax Number:
805-659-9959
Provider Enumeration Date:
08/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 26103 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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