MEDICARE: GWENDOLYN WILSON LMHC, ATR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60963777	WA

General Provider Information

NPI Number	:	1255864583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN WILSON LMHC, ATR

Provider Business Mailing Address
First Line	:	1833 N 105TH ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-8973
Country	:	US
Telephone Number	:	206-888-4437
Fax Number	:	206-203-1979

Provider Business Practice Location Address
First Line	:	1833 N 105TH ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-8973
Country	:	US
Telephone Number	:	206-888-4437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/23/2025

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