Provider Demographics
NPI:1609036656
Name:WILKINS, RENEE H (PSY D, MP)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:H
Last Name:WILKINS
Suffix:
Gender:F
Credentials:PSY D, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-0178
Mailing Address - Country:US
Mailing Address - Phone:505-290-4551
Mailing Address - Fax:505-658-2398
Practice Address - Street 1:200 N 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3905
Practice Address - Country:US
Practice Address - Phone:505-290-4551
Practice Address - Fax:505-658-2398
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY-RXP0034103TP0016X
NMPSY0897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)