Provider Demographics
NPI:1205117819
Name:SCOVILLE, VICTORIA DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DANIELLE
Last Name:SCOVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:DANIELLE
Other - Last Name:WEICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-4450
Mailing Address - Country:US
Mailing Address - Phone:580-445-8106
Mailing Address - Fax:405-751-6488
Practice Address - Street 1:1100 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-4450
Practice Address - Country:US
Practice Address - Phone:405-528-7721
Practice Address - Fax:405-528-7731
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKK8600134Medicaid