Provider Demographics
NPI:1780790287
Name:WICKERT, JAMES JAY (LICD PROF COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JAY
Last Name:WICKERT
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Gender:M
Credentials:LICD PROF COUNSELOR
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Mailing Address - Street 1:165 SOUTH UNION BLVD
Mailing Address - Street 2:# 570 WESTSIDE BEHAVIORAL CARE INC
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:303-397-0343
Mailing Address - Fax:303-986-4973
Practice Address - Street 1:165 SOUTH UNION BLVD
Practice Address - Street 2:# 570 WESTSIDE BEHAVIORAL CARE INC
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228
Practice Address - Country:US
Practice Address - Phone:303-397-0343
Practice Address - Fax:303-986-4973
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional