Provider Demographics
NPI:1679941983
Name:MICHELE WILKENS PSYD A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:MICHELE WILKENS PSYD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-375-8175
Mailing Address - Street 1:65 N MADISON AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2047
Mailing Address - Country:US
Mailing Address - Phone:323-375-8175
Mailing Address - Fax:
Practice Address - Street 1:65 N MADISON AVE STE 601
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2047
Practice Address - Country:US
Practice Address - Phone:323-375-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25549103TC0700X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty