Provider Demographics
NPI:1134370042
Name:WICK, LYNDA L (LPCC-SUPV)
Entity type:Individual
Prefix:MISS
First Name:LYNDA
Middle Name:L
Last Name:WICK
Suffix:
Gender:F
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E POPLAR ST
Mailing Address - Street 2:ASPEN FAMILY CENTER
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2754
Mailing Address - Country:US
Mailing Address - Phone:937-493-4673
Mailing Address - Fax:937-493-4694
Practice Address - Street 1:317 E POPLAR ST
Practice Address - Street 2:ASPEN FAMILY CENTER
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2754
Practice Address - Country:US
Practice Address - Phone:937-493-4673
Practice Address - Fax:937-493-4694
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004136101YP2500X
OHE0001623SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional