| Doctor Name: | MS. VICKY INTHAVONG |
| NPI Number: | 1164768743 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | |
| Business Practice Address: | 15301 Warren Shingle Rd Beale Afb, CA - 959031907 |
| Business Phone Number: | 5306343420 |
| Business Fax Number: | |
| Mailing Address: | 15301 Warren Shingle Rd, BEALE AFB |
| State: | CA |
| Postal Code: | 959031907 |
| Phone Number: | 5306343420 |
| Fax Number: | |
| NPI Enumeration Date: | 12/31/2012 |
| NPI Last Update Date: | 09/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |