MEDICARE: JANET LYNN WILSON MFT

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	103T00000X	Psychologist	6301010693	MI
2	106H00000X	Marriage & Family Therapist	MFC40413	CA

General Provider Information

NPI Number	:	1447244611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET LYNN WILSON MFT

Provider Business Mailing Address
First Line	:	9968 HIBERT ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1035
Country	:	US
Telephone Number	:	760-445-4967
Fax Number	:	619-956-0153

Provider Business Practice Location Address
First Line	:	9968 HIBERT ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1035
Country	:	US
Telephone Number	:	760-445-4967
Fax Number	:	619-956-0153

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	09/11/2025

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