Active NPI
Robin Denise Vickery, LPC
- Professional Counselor
- Poplar Bluff, MO
National Provider Identifier
1083638506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2001020523
- Practice address
- 3001 Warrior LN
Poplar Bluff, MO 63901-8685 - Phone
- (573) 686-1200
- Fax
- (573) 686-1029
- NPI assigned
- Jul 27, 2006
- Last updated
- Jan 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2001020523 | MO | Primary |
Addresses
Primary practice location
3001 Warrior LN
Poplar Bluff, MO 63901-8685
Mailing address
PO Box 280
Poplar Bluff, MO 63902-0280
Phone (573) 686-1200
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11621287 | Other | CAQH | |
| 431116734 | Other | EAP INTERFACE | |
| 431116734 | Other | VALUE OPTIONS | |
| 763085 | Other | HEALTHLINK HMO | |
| 495346504 | Medicaid | MO | |
| 152958 | Other | BLUE CROSS BLUE SHIELD | |
| 9875 | Other | EAP FEI BEHAVIORAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001020523 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1083638506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 280",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639020280",
"telephone_number": "573-686-1200",
"fax_number": "573-686-1029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 WARRIOR LN",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639018685",
"telephone_number": "573-686-1200",
"fax_number": "573-686-1029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKERY",
"first_name": "ROBIN",
"middle_name": "DENISE",
"name_prefix": "Miss",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2001020523",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11621287",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EAP INTERFACE",
"identifier": "431116734",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "431116734",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK HMO",
"identifier": "763085",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "495346504",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "152958",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EAP FEI BEHAVIORAL HEALTH",
"identifier": "9875",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.