Provider Demographics
NPI:1881992337
Name:BENTON, VICKIE LYNNE (LPC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNNE
Last Name:BENTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:L
Other - Last Name:KILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4634
Mailing Address - Country:US
Mailing Address - Phone:405-385-9160
Mailing Address - Fax:
Practice Address - Street 1:920 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4634
Practice Address - Country:US
Practice Address - Phone:405-385-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6645101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty