Provider Demographics
NPI:1003207705
Name:WICKER, TONICA (LMHC)
Entity Type:Individual
Prefix:DR
First Name:TONICA
Middle Name:
Last Name:WICKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 PHEASANT CREST RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9205
Mailing Address - Country:US
Mailing Address - Phone:808-292-4919
Mailing Address - Fax:
Practice Address - Street 1:5018 PHEASANT CREST RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9205
Practice Address - Country:US
Practice Address - Phone:808-292-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11983101YM0800X
FLTPMC3197101YM0800X
WALH60461035101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional