Provider Demographics
NPI:1326146655
Name:WILDER-DOYLE, MARIA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WILDER-DOYLE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 S SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1418
Mailing Address - Country:US
Mailing Address - Phone:970-433-1829
Mailing Address - Fax:
Practice Address - Street 1:327 N 7TH ST
Practice Address - Street 2:STE 25
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3402
Practice Address - Country:US
Practice Address - Phone:970-433-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist