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1255473211 NPI number — TERRILL SHARON LEVINSON WICKHAM PH.D.

NPI Number: 1255473211
Health Care Provider/Practitioner: TERRILL SHARON LEVINSON WICKHAM PH.D.

Information about “1255473211” NPI (TERRILL SHARON LEVINSON WICKHAM PH.D.) exists in 1255473211 in HTML format HTML  |  1255473211 in plain Text format TXT  |  1255473211 in PDF (Portable Document Format) PDF  |  1255473211 in an XML format XML  formats.

NPI Number : 1255473211 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255473211",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEVINSON WICKHAM",
    "FirstName": "TERRILL",
    "MiddleName": "SHARON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LEVINSON",
    "OtherFirstName": "TERRILL",
    "OtherMiddleName": "SHARON",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1210 NEVADA ST",
    "SecondLineMailingAddress": "SUITE101",
    "MailingAddressCityName": "REDLANDS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92374-2895",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-793-8312",
    "MailingAddressFaxNumber": "909-792-6507",
    "FirstLinePracticeLocationAddress": "1210 NEVADA ST",
    "SecondLinePracticeLocationAddress": "SUITE101",
    "PracticeLocationAddressCityName": "REDLANDS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92374-2895",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-793-8312",
    "PracticeLocationAddressFaxNumber": "909-792-6507",
    "EnumerationDate": "02/13/2007",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TA0700X",
          "TaxonomyName": "Adult Development & Aging Psychologist",
          "LicenseNumber": "PSY8407",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TB0200X",
          "TaxonomyName": "Cognitive & Behavioral Psychologist",
          "LicenseNumber": "PSY8407",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSY8407",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC2200X",
          "TaxonomyName": "Clinical Child & Adolescent Psychologist",
          "LicenseNumber": "PSY8407",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TM1800X",
          "TaxonomyName": "Intellectual & Developmental Disabilities Psychologist",
          "LicenseNumber": "PSY8407",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "PSY8407",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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