Provider Demographics
NPI:1407062144
Name:WICKLMAN, DONALD ARTHUR (DMIN, LMFT, CAP)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ARTHUR
Last Name:WICKLMAN
Suffix:
Gender:M
Credentials:DMIN, LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 PARINI WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7088
Mailing Address - Country:US
Mailing Address - Phone:561-964-4091
Mailing Address - Fax:
Practice Address - Street 1:12794 W FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4710
Practice Address - Country:US
Practice Address - Phone:561-795-1518
Practice Address - Fax:561-795-1629
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist