Provider Demographics
NPI:1972526010
Name:WILKINS, PETER BROOK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:BROOK
Last Name:WILKINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 MARQUITA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4054 MCKINNEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8212
Practice Address - Country:US
Practice Address - Phone:214-520-6308
Practice Address - Fax:214-521-9172
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7239Medicare ID - Type UnspecifiedNEW MEDICARE NUMBER
TX611822Medicare ID - Type Unspecified