Provider Demographics
NPI:1295005197
Name:MOOREHOUSE, VICKI BLAKE (LPC-MHSP, SAP, LMHC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:BLAKE
Last Name:MOOREHOUSE
Suffix:
Gender:F
Credentials:LPC-MHSP, SAP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 BRISTOL HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2932
Mailing Address - Country:US
Mailing Address - Phone:423-483-2376
Mailing Address - Fax:423-975-0222
Practice Address - Street 1:4132 BRISTOL HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2932
Practice Address - Country:US
Practice Address - Phone:423-483-2376
Practice Address - Fax:423-975-0222
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10587101YM0800X
TN2788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health