MEDICARE: MS. DENISE WILKERSON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF 68137	CA
2	106H00000X	Marriage & Family Therapist	LMFT 97794	CA

General Provider Information

NPI Number	:	1275880460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE WILKERSON LMFT

Provider Business Mailing Address
First Line	:	1210 CENTRAL BLVD STE 125
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2360
Country	:	US
Telephone Number	:	925-375-5516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 CENTRAL BLVD STE 125
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2360
Country	:	US
Telephone Number	:	925-375-5516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	11/29/2018

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