Provider Demographics
NPI:1780753806
Name:MINERVA, VICKI (LMFT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:MINERVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8371 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4406
Mailing Address - Country:US
Mailing Address - Phone:408-848-8793
Mailing Address - Fax:408-848-3354
Practice Address - Street 1:8371 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4406
Practice Address - Country:US
Practice Address - Phone:408-848-8793
Practice Address - Fax:408-848-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM17961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health