Provider Demographics
NPI:1437159514
Name:CHARLES M VICKERS LSCSW PA
Entity Type:Organization
Organization Name:CHARLES M VICKERS LSCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-271-7848
Mailing Address - Street 1:1601 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2646
Mailing Address - Country:US
Mailing Address - Phone:785-271-7848
Mailing Address - Fax:785-246-6361
Practice Address - Street 1:1601 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2646
Practice Address - Country:US
Practice Address - Phone:785-271-7848
Practice Address - Fax:785-246-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1833261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
S45209Medicare UPIN
KS069419Medicare ID - Type Unspecified