Provider Demographics
NPI:1821976028
Name:WICK, SAMANTHA (LMFT-T)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WICK
Suffix:
Gender:F
Credentials:LMFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8645 COLLEGE BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2034
Mailing Address - Country:US
Mailing Address - Phone:913-214-2511
Mailing Address - Fax:
Practice Address - Street 1:8645 COLLEGE BLVD STE 125
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2034
Practice Address - Country:US
Practice Address - Phone:913-214-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03756-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist