=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285500231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE ALENA WICK LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2025
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3705 MEDICAL PKWY STE 410
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-374-5066
-----------------------------------------------------
Fax | 719-623-0165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 129 DELTA CRST
-----------------------------------------------------
City | MAXWELL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78656-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-374-5066
-----------------------------------------------------
Fax | 719-623-0165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 88455
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------