Provider Demographics
NPI:1871107573
Name:WILCOX, MARCY J (LPC)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:J
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SKY PARK DR STE 207
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5889
Mailing Address - Country:US
Mailing Address - Phone:541-601-0005
Mailing Address - Fax:458-226-2003
Practice Address - Street 1:1600 SKY PARK DR STE 207
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5889
Practice Address - Country:US
Practice Address - Phone:541-601-0005
Practice Address - Fax:458-226-2003
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health