Provider Demographics
NPI:1033127386
Name:WIGLEY, JAMES MACK (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MACK
Last Name:WIGLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 TRAWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2033
Mailing Address - Country:US
Mailing Address - Phone:512-423-6876
Mailing Address - Fax:
Practice Address - Street 1:11811 TRAWOOD PATH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-2033
Practice Address - Country:US
Practice Address - Phone:512-423-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional