Individual
MANDEE WILKINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPA, LSSP, NCSP
Contact information
Practice address
1340 N WHITE CHAPEL BLVD STE 130, SOUTHLAKE, TX 76092-4327
(817) 381-6569
Mailing address
1340 N WHITE CHAPEL BLVD STE 130, SOUTHLAKE, TX 76092-4327
(936) 714-1985
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
38526
TX
103TB0200X
Cognitive & Behavioral Psychologist
38526
TX
103TC2200X
Clinical Child & Adolescent Psychologist
38526
TX
103TM1800X
Intellectual & Developmental Disabilities Psychologist
38526
TX
103TS0200X
School Psychologist
33485
TX
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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