MEDICARE: MR. THOMAS W. WICKHAM L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	18372	TX
2	101YM0800X	Mental Health Counselor	18372	TX
3	101YP2500X	Professional Counselor	18372	TX

General Provider Information

NPI Number	:	1699832121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS W. WICKHAM L.P.C.

Provider Business Mailing Address
First Line	:	321 RED OAK LN
Second Line	:
City	:	INGRAM
State	:	TX
Zip	:	78025-3616
Country	:	US
Telephone Number	:	830-377-8114
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 RED OAK LN
Second Line	:
City	:	INGRAM
State	:	TX
Zip	:	78025-3616
Country	:	US
Telephone Number	:	830-377-8114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	09/11/2025

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