Provider Demographics
NPI:1922651249
Name:VICK, TIMOTHY AARON
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:AARON
Last Name:VICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-1723
Mailing Address - Country:US
Mailing Address - Phone:405-446-2751
Mailing Address - Fax:
Practice Address - Street 1:5101 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-1723
Practice Address - Country:US
Practice Address - Phone:405-446-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)