Provider Demographics
NPI:1174676142
Name:WEST, VICKIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VICKIE
Other - Middle Name:L
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLINICALPSYCHOLOGIST
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-0297
Mailing Address - Country:US
Mailing Address - Phone:479-521-4909
Mailing Address - Fax:
Practice Address - Street 1:179 N CHURCH AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5267
Practice Address - Country:US
Practice Address - Phone:479-521-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86-20P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59194OtherBCBS PROVIDER NUMBER
AR50286000000OtherQUAL CHOICE PROVIDER
AR029116OtherVALUE OPTIONS