Etisha Wilbon, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

103673 Issued in CA

Practice address

2550 W Clinton Ave Ste 116
Fresno, CA 93705-4206

Phone

(209) 373-5245

NPI assigned

Mar 26, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Marriage & Family Therapist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1659765618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W. CLINTON AVE",
            "address_2": "BUILDING C, SUITE 256",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93705",
            "telephone_number": "559-396-9257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 W CLINTON AVE STE 116",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937054206",
            "telephone_number": "209-373-5245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2181 S El Camino Real Ste 204",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "CA",
            "postal_code": "920546288",
            "country_code": "US",
            "telephone_number": "619-549-0329 x721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILBON",
        "first_name": "ETISHA",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-26",
        "last_updated": "2021-08-11",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "103673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elauria Tase Wiggins
• Michael H Wiggins, MD
• Sherry K Wiggins, CRNA
• Alexis Ann Wigh
• Akna D Wijekularatne, DO
• Heather Eileen Wilbour, SUDRC
• Brandon Wilbur
• Kathryn Cressy Wilbur, LCSW 74612
• Albert T. Wilburn, MD
• Jessica Wilcox

• Marriage & Family Therapist in Fresno, CA
• Providers in Fresno, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.