Provider Demographics
NPI:1154516219
Name:WICKENS, TASHA M (LCPC)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:M
Last Name:WICKENS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81592
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59108-1592
Mailing Address - Country:US
Mailing Address - Phone:406-855-6278
Mailing Address - Fax:
Practice Address - Street 1:1643 LEWIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4151
Practice Address - Country:US
Practice Address - Phone:406-855-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MT1322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health