1841366739 NPI number — MRS. MARCIA RUTH WILCOX LMFT

Table of content: MRS. MARCIA RUTH WILCOX LMFT (NPI 1841366739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841366739 NPI number — MRS. MARCIA RUTH WILCOX LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILCOX
Provider First Name:
MARCIA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT
Provider Other First Name:
MARCIA
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841366739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
484 MOBIL AVE
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-795-1962
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
484 MOBIL AVE
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-795-1962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2006

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: 106H00000X , with the licence number:  39749 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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