Provider Demographics
NPI:1770231466
Name:WICK THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:WICK THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-292-0882
Mailing Address - Street 1:6918 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-5139
Mailing Address - Country:US
Mailing Address - Phone:805-292-0882
Mailing Address - Fax:
Practice Address - Street 1:7950 S LINCOLN ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2713
Practice Address - Country:US
Practice Address - Phone:805-292-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty