Provider Demographics
NPI:1740616226
Name:VICK, GAYLA FAE
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:FAE
Last Name:VICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GAYLA
Other - Middle Name:FAE
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 S. CENTRAL, SUITE 101
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-5793
Mailing Address - Fax:541-776-5798
Practice Address - Street 1:215 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2844
Practice Address - Country:US
Practice Address - Phone:541-772-1209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst