Provider Demographics
NPI:1275085490
Name:AUGUST, VIKKI
Entity Type:Individual
Prefix:
First Name:VIKKI
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 S TORREY PINES DR UNIT 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4463
Mailing Address - Country:US
Mailing Address - Phone:702-848-0718
Mailing Address - Fax:702-853-6722
Practice Address - Street 1:5135 CAMINO AL NORTE STE 251
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031
Practice Address - Country:US
Practice Address - Phone:702-853-6719
Practice Address - Fax:702-853-6719
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician