Provider Demographics
NPI:1609125517
Name:WICK, KIMBERLY JANE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JANE
Last Name:WICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 TOWNSGATE RD STE 780
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5701
Mailing Address - Country:US
Mailing Address - Phone:310-285-5030
Mailing Address - Fax:
Practice Address - Street 1:2660 TOWNSGATE RD STE 780
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5701
Practice Address - Country:US
Practice Address - Phone:310-285-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist