Healthcare Provider Details

I. General information

NPI: 1114576261
Provider Name (Legal Business Name): BRITTNEY NICOLE WILKINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6763 PAGE AVE
SAINT LOUIS MO
63133-1635
US

IV. Provider business mailing address

1430 OLIVE ST STE 400
SAINT LOUIS MO
63103-2303
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-1720
  • Fax:
Mailing address:
  • Phone: 314-206-3700
  • Fax: 314-371-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019016787
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: