1790651404 NPI number — AUSOME KULTURE BEHAVIORAL, LLC

Table of content: CAROL LEE WILKINSON M.D., PHD. (NPI 1588953467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790651404 NPI number — AUSOME KULTURE BEHAVIORAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSOME KULTURE BEHAVIORAL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1790651404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1522 LAKE CRYSTAL DR APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33411-2081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-232-0492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1522 LAKE CRYSTAL DR APT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-232-0492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
JASMINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-232-0492

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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