MEDICARE: THOMAS B WILKINSON LPCC, LICDC

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	101Y00000X	Counselor	E0002163	OH

General Provider Information

NPI Number	:	1457348880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS B WILKINSON LPCC, LICDC

Provider Business Mailing Address
First Line	:	1600 GLENDALE MILFORD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1231
Country	:	US
Telephone Number	:	513-594-8373
Fax Number	:	937-293-0650

Provider Business Practice Location Address
First Line	:	2670 WOODMAN CENTER CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-1477
Country	:	US
Telephone Number	:	513-594-8373
Fax Number	:	937-293-0650

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/29/2011

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