Provider Demographics
NPI:1316677669
Name:WIGGINS, MCKENNA (LPC)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7747
Mailing Address - Country:US
Mailing Address - Phone:903-535-7355
Mailing Address - Fax:903-535-7384
Practice Address - Street 1:575 W STATE HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2113
Practice Address - Country:US
Practice Address - Phone:903-597-1351
Practice Address - Fax:903-535-7384
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health