Provider Demographics
NPI:1932677085
Name:WICKS THERAPY
Entity Type:Organization
Organization Name:WICKS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-805-4036
Mailing Address - Street 1:3304 CROYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2079
Mailing Address - Country:US
Mailing Address - Phone:616-805-4036
Mailing Address - Fax:
Practice Address - Street 1:3304 CROYDEN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2079
Practice Address - Country:US
Practice Address - Phone:616-805-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty