Healthcare Provider Details

I. General information

NPI: 1861600421
Provider Name (Legal Business Name): HOLLY DENISE WILKES MS, LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S BRIDGE ST STE A
BELDING MI
48809-1764
US

IV. Provider business mailing address

720 CENTER ST
MASON MI
48854-1073
US

V. Phone/Fax

Practice location:
  • Phone: 616-902-9007
  • Fax:
Mailing address:
  • Phone: 734-778-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025290
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: