Provider Demographics
NPI:1477823854
Name:WILKEY, HOLLY ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:WILKEY
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 1:16008 VIA DICHA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92091-4252
Mailing Address - Country:US
Mailing Address - Phone:760-415-0122
Mailing Address - Fax:760-454-0444
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:SUITE C159
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2767
Practice Address - Country:US
Practice Address - Phone:760-415-0122
Practice Address - Fax:760-454-0444
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist