Provider Demographics
NPI:1790717288
Name:WILKISON, MARSHA L (ED S LMHP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:WILKISON
Suffix:
Gender:F
Credentials:ED S LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W 3RD ST
Mailing Address - Street 2:PO BOX 818
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-2527
Mailing Address - Country:US
Mailing Address - Phone:308-345-2770
Mailing Address - Fax:308-345-2557
Practice Address - Street 1:1012 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-2527
Practice Address - Country:US
Practice Address - Phone:308-345-2770
Practice Address - Fax:308-345-2557
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6251OtherMIDLANDS CHOICE
84892OtherBCBS DIRECT PROVIDER
97085OtherBCBS AUXILLIARY PROVIDER