Provider Demographics
NPI:1861103293
Name:WILCOX, PAUL (LMFT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WILCOX
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 BOYSENBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-4614
Mailing Address - Country:US
Mailing Address - Phone:949-280-1676
Mailing Address - Fax:
Practice Address - Street 1:785 GRAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2371
Practice Address - Country:US
Practice Address - Phone:760-453-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT136207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist