Provider Demographics
NPI:1285019042
Name:WIKSELL, TORIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TORIE
Middle Name:
Last Name:WIKSELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SE 192ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7475
Mailing Address - Country:US
Mailing Address - Phone:619-736-3078
Mailing Address - Fax:
Practice Address - Street 1:2005 SE 192ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7475
Practice Address - Country:US
Practice Address - Phone:619-736-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100.0134195106H00000X
WALF61401189106H00000X
ORT2355106H00000X
CA106471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist