Provider Demographics
NPI:1740232545
Name:JEFFERIES, VIVIAN CATES (MED, LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:CATES
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:MED, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6946 ELK RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-8031
Mailing Address - Country:US
Mailing Address - Phone:806-787-5588
Mailing Address - Fax:
Practice Address - Street 1:3305 81ST ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2042
Practice Address - Country:US
Practice Address - Phone:806-784-0909
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional