Provider Demographics
NPI:1124360284
Name:WILCOX, ERIC FOREST (MA PSYCHOLOGY)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:FOREST
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 D ST FL 3
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0455
Mailing Address - Country:US
Mailing Address - Phone:707-476-2274
Mailing Address - Fax:707-476-1299
Practice Address - Street 1:134 D ST FL 3
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0455
Practice Address - Country:US
Practice Address - Phone:707-476-2274
Practice Address - Fax:707-476-1299
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist