MEDICARE: MR. CORY JAMAL WILKIN MS, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC51433	CA

General Provider Information

NPI Number	:	1063546463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORY JAMAL WILKIN MS, LMFT

Provider Business Mailing Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	SUITE 200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-371-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	SUITE 200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-371-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	09/05/2012

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