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NPI Code Detail

MEDICARE: NELL CATHRYN WICKSTROM AMFT

MEDICARE: NELL CATHRYN WICKSTROM AMFT
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
1106H00000XMarriage & Family Therapist141486CA
2390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101536011OTHERCAMEDICAL

General Provider Information

NPI Number : 1679297881
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELL CATHRYN WICKSTROM AMFT
Provider Business Mailing Address
First Line : 345 S SAN PEDRO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90013-1633
Country : US
Telephone Number : 213-819-8382
Fax Number :
Provider Business Practice Location Address
First Line : 345 S SAN PEDRO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90013-1633
Country : US
Telephone Number : 213-819-8382
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2022
Last Update Date : 11/15/2023

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Directions to “ NELL CATHRYN WICKSTROM AMFT” Practice Location

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