Provider Demographics
NPI:1528424561
Name:WIKEL, TAYLOR (CLINICIAN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WIKEL
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29808 URTICA CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-0319
Mailing Address - Country:US
Mailing Address - Phone:951-290-2785
Mailing Address - Fax:
Practice Address - Street 1:41877 ENTERPRISE CIR N
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5656
Practice Address - Country:US
Practice Address - Phone:951-290-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA104584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist