Provider Demographics
NPI:1184114019
Name:WILKINSON, HARRY (DBA)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STILLFOREST ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7518
Mailing Address - Country:US
Mailing Address - Phone:713-851-2709
Mailing Address - Fax:
Practice Address - Street 1:55 STILLFOREST ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7518
Practice Address - Country:US
Practice Address - Phone:713-851-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY1650103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty