Provider Demographics
NPI:1679626303
Name:VICKREY, NOREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:
Last Name:VICKREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S ALMA SCHOOL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2078
Mailing Address - Country:US
Mailing Address - Phone:972-559-2538
Mailing Address - Fax:480-827-1551
Practice Address - Street 1:5525 N MACARTHUR BLVD STE 800
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2646
Practice Address - Country:US
Practice Address - Phone:972-550-2538
Practice Address - Fax:480-827-1551
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000N09C0Medicaid
TX0N09CMedicare ID - Type Unspecified