Basic Information
| Provider Information | |||||||||
| NPI: | 1558345876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUMLEY | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13720 VASILI DR | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995776701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075802181 | ||||||||
| FaxNumber: | 9075801776 | ||||||||
| Practice Location | |||||||||
| Address1: | 5955 ZEAMER AVE | ||||||||
| Address2: | 3 MDOS/SGOH | ||||||||
| City: | ELMENDORF AFB | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995063702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075802089 | ||||||||
| FaxNumber: | 9075801776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1252 | AL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.