Amanda M. Wickett, PSYD, H.S.P.P.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20042052A Issued in IN

Practice address

1807 Smith St
Logansport, IN 46947-1576

Phone

(574) 732-1414

Fax

(574) 732-0504

NPI assigned

Jun 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Thrive Counseling LLC

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300

  IN, MA

  Medicare reassignment Care Compare group NPD
• Four County Comprehensive Mental Health Center, Inc

  • Psychiatric Hospital
  • Peru, IN
  • NPI 1457539751
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770511149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 SMITH ST",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471576",
            "telephone_number": "574-732-1414",
            "fax_number": "574-732-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 SMITH ST",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471576",
            "telephone_number": "574-732-1414",
            "fax_number": "574-732-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKETT",
        "first_name": "AMANDA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PSYD, H.S.P.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042052A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HSPP LICENSE",
            "identifier": "20042052A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Steven Weinstein, MD
• Alainna Wen, MA
• Angel White, RN
• Brandon L Whitehead, RDN
• Kaitlin Wickersham-Shafer, NP
• Kathy Wierzchowski, MS
• Rebeccah A Wiley, BS
• Gabriella Williams
• Stacy Lynn Williams, MBA
• James Cary Wilson, BSW

• Psychologist in Logansport, IN
• Providers in Logansport, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.