Provider Demographics
NPI:1063764918
Name:WILHELM, ELLYN K (LPC)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:K
Last Name:WILHELM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 N MEADOWLARK WAY
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-5041
Mailing Address - Country:US
Mailing Address - Phone:208-772-3116
Mailing Address - Fax:208-772-7677
Practice Address - Street 1:7905 N MEADOWLARK WAY
Practice Address - Street 2:SUITE A&B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-772-3116
Practice Address - Fax:208-772-7677
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional