Provider Demographics
NPI:1659853836
Name:SHACKELFORD, VICKI (LPC)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SHACKELFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2525 WALLINGWOOD DRIVE
Mailing Address - Street 2:BLDG 1 SUITE 209
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-461-9544
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DRIVE
Practice Address - Street 2:BLDG 1, SUITE 209
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-461-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health