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General NPI Number Information
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NPI Number | 1225890387
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Entity Type | Individual
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Provider Name | PETRA P WILKES MFT, MHC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1404 DEL PRADO BLVD S STE 135
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City | CAPE CORAL
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State | FL
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Zip | 33990-3782
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Country | US
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Telephone | 978-310-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 4085 HANCOCK BRIDGE PKWY STE 112-116
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-7219
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Country | US
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Telephone | 978-310-1212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH25031
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License Number State | FL
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