Active NPI
Vikki Bouck, LCSW
- Mental Health Counselor
- La Mesa, CA
National Provider Identifier
1790142875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 23706
- Practice address
- 3665 Avocado Village CT
Unit 165
La Mesa, CA 91941-7375 - Phone
- (619) 665-4142
- NPI assigned
- Jan 20, 2016
- Last updated
- Jan 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 23706 | CA | Primary |
Addresses
Primary practice location
3665 Avocado Village CT
Unit 165
La Mesa, CA 91941-7375
Mailing address
3665 Avocado Village CT
Unit 165
La Mesa, CA 91941-7375
Phone (619) 665-4142
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 |
|---|---|---|---|
| 23706 | CA | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453248000000",
"number": "1790142875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3665 AVOCADO VILLAGE CT",
"address_2": "UNIT 165",
"city": "LA MESA",
"state": "CA",
"postal_code": "919417375",
"telephone_number": "619-665-4142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3665 AVOCADO VILLAGE CT",
"address_2": "UNIT 165",
"city": "LA MESA",
"state": "CA",
"postal_code": "919417375",
"telephone_number": "619-665-4142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCK",
"first_name": "VIKKI",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-20",
"last_updated": "2016-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "23706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.