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General NPI Number Information
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NPI Number | 1134370042
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Entity Type | Individual
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Provider Name | LYNDA L WICK LPCC-SUPV
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Gender | Female
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 317 E POPLAR ST ASPEN FAMILY CENTER
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City | SIDNEY
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State | OH
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Zip | 45365-2754
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Country | US
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Telephone | 937-493-4673
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Fax | 937-493-4694
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Provider Business Mailing Address
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Address Line | 317 E POPLAR ST ASPEN FAMILY CENTER
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City | SIDNEY
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State | OH
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Zip | 45365-2754
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Country | US
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Telephone | 937-493-4673
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Fax | 937-493-4694
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004136
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0001623SUPV
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License Number State | OH
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