Healthcare Provider Details

I. General information

NPI: 1396894366
Provider Name (Legal Business Name): BRIDGET WILCOX PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S BEVERLY DR SUITE 100
BEVERLY HILLS CA
90212-4426
US

IV. Provider business mailing address

420 S BEVERLY DR. SUITE 100
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 323-875-4132
  • Fax:
Mailing address:
  • Phone: 323-875-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: