Provider Demographics
NPI:1710221965
Name:VICKERS, LORI ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28991 OLD TOWN FRONT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2858
Mailing Address - Country:US
Mailing Address - Phone:951-264-1226
Mailing Address - Fax:951-308-1515
Practice Address - Street 1:28991 OLD TOWN FRONT ST STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2858
Practice Address - Country:US
Practice Address - Phone:951-264-1226
Practice Address - Fax:951-308-1515
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist