Provider Demographics
NPI:1053059105
Name:WICK PSYCHOTHERAPY
Entity Type:Organization
Organization Name:WICK PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-910-3108
Mailing Address - Street 1:7959 S BAY CURV
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1120
Mailing Address - Country:US
Mailing Address - Phone:612-910-3108
Mailing Address - Fax:
Practice Address - Street 1:1001 TWELVE OAKS CENTER DR STE 1030E
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4320
Practice Address - Country:US
Practice Address - Phone:612-910-3108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health