Provider Demographics
NPI:1730184474
Name:MCCALL, VICKI LYNNE (LPC)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNNE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 OAK LAKE CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3247
Mailing Address - Country:US
Mailing Address - Phone:901-355-5747
Mailing Address - Fax:
Practice Address - Street 1:3150 LENOX PARK BLVD
Practice Address - Street 2:STE 214
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4299
Practice Address - Country:US
Practice Address - Phone:901-273-2372
Practice Address - Fax:901-273-2351
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441913Medicaid