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NPI Code Detail

MEDICARE: MS. KATHLEEN WILSON-PARISH

MEDICARE: MS. KATHLEEN WILSON-PARISH
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
1101YM0800XMental Health CounselorIMF 50499CA

General Provider Information

NPI Number : 1780807636
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN WILSON-PARISH
Provider Business Mailing Address
First Line : 1567 PURPLE MARTIN LN
Second Line :
City : MANTECA
State : CA
Zip : 95337-7906
Country : US
Telephone Number : 209-824-9607
Fax Number : 209-956-4245
Provider Business Practice Location Address
First Line : 6707 EMBARCADERO DR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-3382
Country : US
Telephone Number : 209-956-4240
Fax Number : 209-956-4245
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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Directions to “ MS. KATHLEEN WILSON-PARISH ” Practice Location

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