Provider Demographics
NPI:1174685747
Name:BERNARD, VICKI R (PHD, LMFT,LPC)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:R
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PHD, LMFT,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 LINDELL BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2927
Mailing Address - Country:US
Mailing Address - Phone:314-956-8100
Mailing Address - Fax:314-389-8744
Practice Address - Street 1:4144 LINDELL BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2927
Practice Address - Country:US
Practice Address - Phone:314-956-8100
Practice Address - Fax:314-389-8744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001695101YP2500X
MO106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist