Provider Demographics
NPI:1730227265
Name:WILBUR, KATHLEEN E (LCMHC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:WILBUR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SIMON ST
Mailing Address - Street 2:UNIT 2A MERRIMACK VALLEY COUNSELING ASSOC
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-888-4347
Mailing Address - Fax:603-577-9157
Practice Address - Street 1:39 SIMON ST
Practice Address - Street 2:UNIT 2A MERRIMACK VALLEY COUNSELING ASSOC
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-888-4347
Practice Address - Fax:603-577-9157
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH80101YM0800X
MA4211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420614Medicaid