Provider Demographics
NPI:1407265176
Name:VICKI LUMLEY, PH.D., LLC
Entity Type:Organization
Organization Name:VICKI LUMLEY, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-549-9917
Mailing Address - Street 1:295 WELLS FARGO DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9421
Mailing Address - Country:US
Mailing Address - Phone:206-327-4854
Mailing Address - Fax:541-843-2832
Practice Address - Street 1:724 SOUTH CENTRAL AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7851
Practice Address - Country:US
Practice Address - Phone:206-327-4854
Practice Address - Fax:541-843-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60310066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty