Provider Demographics
NPI:1548619679
Name:MATTHEWS, VICKI MARIE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:MARIE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPCC
Mailing Address - Street 1:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:ELEPHANT BUTTE
Mailing Address - State:NM
Mailing Address - Zip Code:87935-1354
Mailing Address - Country:US
Mailing Address - Phone:575-520-1919
Mailing Address - Fax:575-520-1919
Practice Address - Street 1:405 N DATE ST STE 9
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-2378
Practice Address - Country:US
Practice Address - Phone:575-520-1919
Practice Address - Fax:575-520-1919
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8817101YP2500X
NMCCMH0220321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional