Provider Demographics
NPI:1366970352
Name:WIKELIUS, DARCI JEAN (PSYD, LP)
Entity type:Individual
Prefix:MRS
First Name:DARCI
Middle Name:JEAN
Last Name:WIKELIUS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:DARCI
Other - Middle Name:
Other - Last Name:WIKELIUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP
Mailing Address - Street 1:28 UNION ST N
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1355
Mailing Address - Country:US
Mailing Address - Phone:320-703-8151
Mailing Address - Fax:320-210-1830
Practice Address - Street 1:28 UNION ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1355
Practice Address - Country:US
Practice Address - Phone:320-703-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00932101YP2500X
MNLP6996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194278655OtherRECOVERING HOPE TREATMENT CENTER
MN1336721364OtherMANES FOR CHANGE, LLC