Healthcare Provider Details

I. General information

NPI: 1285500231
Provider Name (Legal Business Name): STEPHANIE ALENA WICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY STE 410
AUSTIN TX
78705-1023
US

IV. Provider business mailing address

129 DELTA CRST
MAXWELL TX
78656-2050
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax: 719-623-0165
Mailing address:
  • Phone: 888-374-5066
  • Fax: 719-623-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: