Provider Demographics
NPI:1831494095
Name:COFFEE-FLETCHER, VICKY LYNN
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:COFFEE-FLETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:LYNN
Other - Last Name:COFFEE-EBRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 MATTHEWS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6143
Mailing Address - Country:US
Mailing Address - Phone:512-775-6324
Mailing Address - Fax:
Practice Address - Street 1:1901 MATTHEWS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6143
Practice Address - Country:US
Practice Address - Phone:512-775-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional