Provider Demographics
NPI:1063555977
Name:WIKINGER-HENRY, MANUELA (MS,MHP,LMFT UNDER SU)
Entity type:Individual
Prefix:MRS
First Name:MANUELA
Middle Name:
Last Name:WIKINGER-HENRY
Suffix:
Gender:F
Credentials:MS,MHP,LMFT UNDER SU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 NE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-7334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4645 W GORE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6041
Practice Address - Country:US
Practice Address - Phone:580-355-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKUNDER SUPERVISION106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist