Provider Demographics
NPI:1790128221
Name:WILKINSON, KATHERINE SIOBHAN (MS, LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SIOBHAN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MS, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 W CHARLESTON BLVD
Mailing Address - Street 2:110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1575
Mailing Address - Country:US
Mailing Address - Phone:702-483-8578
Mailing Address - Fax:702-463-7026
Practice Address - Street 1:7371 W CHARLESTON BLVD
Practice Address - Street 2:110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1575
Practice Address - Country:US
Practice Address - Phone:702-483-8578
Practice Address - Fax:702-463-7026
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01298101YA0400X
NV01186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1790128221Medicaid