Provider Demographics
NPI:1861233900
Name:TEMPLETON, VICKI (MA)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19245 SW HEIGHTSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6082
Mailing Address - Country:US
Mailing Address - Phone:503-488-0088
Mailing Address - Fax:
Practice Address - Street 1:10580 SW MCDONALD ST STE 202
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4800
Practice Address - Country:US
Practice Address - Phone:503-488-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2153532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health