Provider Demographics
NPI:1619536117
Name:JO, VICKIE (MA, LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:JO
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 245TH WAY NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-8689
Mailing Address - Country:US
Mailing Address - Phone:206-228-8425
Mailing Address - Fax:
Practice Address - Street 1:2002 156TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3827
Practice Address - Country:US
Practice Address - Phone:800-682-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60964780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health