Provider Demographics
NPI:1982182218
Name:PERKINS, NICOLE WIDMYER (LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:WIDMYER
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WILSHIRE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1426
Mailing Address - Country:US
Mailing Address - Phone:424-393-3567
Mailing Address - Fax:
Practice Address - Street 1:530 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1426
Practice Address - Country:US
Practice Address - Phone:424-393-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87617106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist