Brian Allen Wicks, MFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3970 Issued in MN

Practice address

8421 Wayzata Blvd Ste 250
Golden Valley, MN 55426-1382

Phone

(952) 835-6540

Fax

(651) 925-0089

NPI assigned

Jan 28, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Por, LLC

  • Case Management Agency
  • Golden Valley, MN
  • NPI 1336460518
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1730710815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8421 WAYZATA BLVD STE 250",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261382",
            "telephone_number": "952-835-6540",
            "fax_number": "651-925-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8421 WAYZATA BLVD STE 250",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261382",
            "telephone_number": "952-835-6540",
            "fax_number": "651-925-0089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKS",
        "first_name": "BRIAN",
        "middle_name": "ALLEN",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bwicks@poremotionalwellness.com",
            "affiliation": "N",
            "endpointDescription": "company secure website",
            "address_1": "8421 Wayzata Blvd Ste 250",
            "city": "Golden Valley",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554261382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Judith Weyl, LMFT
• David A White, SLP
• Rita White, DPT
• Dexter D Whittemore, MD
• Wholehearted Services LLC
• Kayla Marie Wiedmann
• Tracey Lorraine Wiegel, CMT
• Linnea Katharine Will, M.D.
• Amelia Grace Willey
• David Williams, MA, LGSW

• Mental Health Counselor in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.