Provider Demographics
NPI:1164961025
Name:WICKLER BEHAVIORAL CONSULTING CORP.
Entity Type:Organization
Organization Name:WICKLER BEHAVIORAL CONSULTING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLEE
Authorized Official - Middle Name:D'ANN
Authorized Official - Last Name:WICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-246-9784
Mailing Address - Street 1:632 182ND ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6275
Mailing Address - Country:US
Mailing Address - Phone:425-246-9784
Mailing Address - Fax:425-361-2952
Practice Address - Street 1:632 182ND ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6275
Practice Address - Country:US
Practice Address - Phone:425-246-9784
Practice Address - Fax:425-361-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACAAR.CG.60659106101Y00000X
WA1-11-8640103K00000X
WA1-13-14776103K00000X
WARBT-16-20417106S00000X
WARBT-16-23299106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherPRIVATE INSURANCE