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General NPI Number Information
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NPI Number | 1518818012
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Entity Type | Individual
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Provider Name | MARK ALLEN WICK LPCC
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Gender | Male
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 2706 GANNON RD
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City | SAINT PAUL
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State | MN
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Zip | 55116-2642
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Country | US
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Telephone | 612-441-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 9116 MEDLEY RD
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-3118
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Country | US
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Telephone | 218-590-9241
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5438
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License Number State | MN
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