Provider Demographics
NPI:1548479223
Name:FARRIS, VICKIE
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:
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 103
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:KS
Mailing Address - Zip Code:67070-0103
Mailing Address - Country:US
Mailing Address - Phone:620-239-4031
Mailing Address - Fax:620-239-4032
Practice Address - Street 1:304 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZELTON
Practice Address - State:KS
Practice Address - Zip Code:67061-9300
Practice Address - Country:US
Practice Address - Phone:620-239-4031
Practice Address - Fax:620-239-4032
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLADC 103101YA0400X
OKLPC 3783101YM0800X
KS03283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)