Provider Demographics
NPI:1720006638
Name:WILK, ELLA DOVRAT (PSYD LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:DOVRAT
Last Name:WILK
Suffix:
Gender:F
Credentials:PSYD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 PETALUMA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5408
Mailing Address - Country:US
Mailing Address - Phone:561-361-8480
Mailing Address - Fax:561-395-5862
Practice Address - Street 1:6044 PETALUMA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5408
Practice Address - Country:US
Practice Address - Phone:561-361-8480
Practice Address - Fax:561-395-5862
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health