Provider Demographics
NPI:1225890387
Name:WILKES, PETRA P (MFT, MHC)
Entity Type:Individual
Prefix:MRS
First Name:PETRA
Middle Name:P
Last Name:WILKES
Suffix:
Gender:F
Credentials:MFT, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 HANCOCK BRIDGE PKWY STE 112-116
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7219
Mailing Address - Country:US
Mailing Address - Phone:978-310-1212
Mailing Address - Fax:
Practice Address - Street 1:1404 DEL PRADO BLVD S STE 135
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3782
Practice Address - Country:US
Practice Address - Phone:978-310-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health