Provider Demographics
NPI:1699978585
Name:WICKS, CHRISTOPHER G (LIMHP/LICSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:G
Last Name:WICKS
Suffix:
Gender:M
Credentials:LIMHP/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 S. 84TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127
Mailing Address - Country:US
Mailing Address - Phone:402-339-7991
Mailing Address - Fax:402-339-7624
Practice Address - Street 1:6550 S. 84TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127
Practice Address - Country:US
Practice Address - Phone:402-339-7991
Practice Address - Fax:402-339-7624
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7944101YM0800X
NE11121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470804773-26Medicaid