Provider Demographics
NPI:1780855809
Name:WICK, JANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:WICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 COUNTY ROAD 4855
Mailing Address - Street 2:
Mailing Address - City:TIMPSON
Mailing Address - State:TX
Mailing Address - Zip Code:75975-5327
Mailing Address - Country:US
Mailing Address - Phone:936-254-9556
Mailing Address - Fax:
Practice Address - Street 1:689 COUNTY ROAD 4855
Practice Address - Street 2:
Practice Address - City:TIMPSON
Practice Address - State:TX
Practice Address - Zip Code:75975-5327
Practice Address - Country:US
Practice Address - Phone:936-254-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional