1982246203 NPI number — MRS. VICKI LYNN PHILLIPS LMSW

Table of content: MRS. VICKI LYNN PHILLIPS LMSW (NPI 1982246203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982246203 NPI number — MRS. VICKI LYNN PHILLIPS LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
VICKI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELLAND
Provider Other First Name:
VICKI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982246203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMMUNITY BRIDGES INTEGRATED HEALTH
Provider Second Line Business Mailing Address:
4720 RICHMOND SQUARE
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-831-7566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMMUNITY BRIDGES INTEGRATED HEALTH
Provider Second Line Business Practice Location Address:
4720 RICHMOND SQUARE
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-831-7566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2019

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: 104100000X , with the licence number:  8904 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 16560 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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