Provider Demographics
NPI:1518384064
Name:ISELER, VICKI LYNN (MA, LLPC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:ISELER
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246-0038
Mailing Address - Country:US
Mailing Address - Phone:517-960-5110
Mailing Address - Fax:
Practice Address - Street 1:1312 WARREN AVE UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3732
Practice Address - Country:US
Practice Address - Phone:517-960-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI640 101 3558 3276326OtherSTATE OF MICHIGAN PROFESSIONAL COUNSELOR EDUCATIONAL LIMITED LICENSE