Provider Demographics
NPI:1205069853
Name:WICHMAN, AMY D (MS, LMFT-T)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:MS, LMFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-0425
Mailing Address - Country:US
Mailing Address - Phone:785-447-2983
Mailing Address - Fax:
Practice Address - Street 1:719 5TH ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-2936
Practice Address - Country:US
Practice Address - Phone:785-447-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMFT 1074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist