Individual provider · Type 1 NPI

Frederick Marcus Vickery, LPPC, LADC

Professional Counselor · St. Louis Park, MN

NPI number 1215443049 Active

Practice location

6500 Excelsior Blvd
St. Louis Park, MN 55426-4702

Call (952) 993-5000 Map

Mailing address

8170 33rd Avenue, Mailstop 21110Q
Bloomington, MN 55425-4516

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X1835 (MN)
Addiction (Substance Use Disorder) Counselor 101YA0400X304457 (MN)

Professional Counselor: Definition to come...

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About NPI 1215443049

Frederick Marcus Vickery, LPPC, LADC's National Provider Identifier is 1215443049, issued on Dec 15, 2017. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in St. Louis Park, MN. The record was last updated on Sep 4, 2026.