Provider Demographics
NPI:1073583589
Name:FRANK B WICHERN, PHD
Entity Type:Organization
Organization Name:FRANK B WICHERN, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:B
Authorized Official - Last Name:WICHERN
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-234-3178
Mailing Address - Street 1:600 W CAMPBELL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3357
Mailing Address - Country:US
Mailing Address - Phone:972-234-3178
Mailing Address - Fax:972-437-1530
Practice Address - Street 1:600 W CAMPBELL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3357
Practice Address - Country:US
Practice Address - Phone:972-234-3178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21663103TC0700X, 103TC2200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171179OtherVALUE OPTIONS
TX00FC19OtherBLUE CROSS
0004099945OtherAETNA
07984000OtherMAGELLAN HEALTH
72882191OtherUHC