Provider Demographics
NPI:1700144367
Name:WINDSOR, VIVIAN (LPC/MHSP)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:WINDSOR
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-4422
Mailing Address - Country:US
Mailing Address - Phone:731-442-9287
Mailing Address - Fax:
Practice Address - Street 1:2070 PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-4422
Practice Address - Country:US
Practice Address - Phone:731-442-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health