1679886188 NPI number — LINDA ZOE WILKINSON L.A.C.

Table of content: LINDA ZOE WILKINSON L.A.C. (NPI 1679886188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679886188 NPI number — LINDA ZOE WILKINSON L.A.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINSON
Provider First Name:
LINDA
Provider Middle Name:
ZOE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.A.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679886188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 N ALZORA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLLESON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85353-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-907-5963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 W. BELL RD.
Provider Second Line Business Practice Location Address:
BLDG H SUITE 107 COMPLETE COUNSELING SERVICES, LLC
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-291-0945
Provider Business Practice Location Address Fax Number:
623-322-7191
Provider Enumeration Date:
07/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LAC-13398 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)