Provider Demographics
NPI:1598901498
Name:STEINLEY, VICKI S (LPC, CADC III)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:S
Last Name:STEINLEY
Suffix:
Gender:F
Credentials:LPC, CADC III
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:STEINLEY
Other - Last Name:WELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LADC
Mailing Address - Street 1:272 MEDICAL LOOP
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-440-3532
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:272 MEDICAL LOOP
Practice Address - Street 2:SUITE E
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-440-3532
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2681101YP2500X
OR2681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1598907498Medicaid