Provider Demographics
NPI:1962800748
Name:WILCOX, TARI (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:TARI
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3811
Mailing Address - Country:US
Mailing Address - Phone:319-209-0068
Mailing Address - Fax:
Practice Address - Street 1:5925 COUNCIL ST NE
Practice Address - Street 2:SUITE 120
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5878
Practice Address - Country:US
Practice Address - Phone:319-393-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072261106H00000X
IL166.000788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist