Provider Demographics
NPI:1962392449
Name:WILKES, MARK (LMFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WILKES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10784 N 5250 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8886
Mailing Address - Country:US
Mailing Address - Phone:916-945-7284
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 13
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5193
Practice Address - Country:US
Practice Address - Phone:801-893-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13409753-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist