Healthcare Provider Details

I. General information

NPI: 1992486443
Provider Name (Legal Business Name): CRESCENDO BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 10/01/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAYNE R. WILSON 70 WEST TERRACE ST
ALTA DENA CA
91001
US

IV. Provider business mailing address

736 BRIDGE ST UNIT 11
VERNONIA OR
97064-1285
US

V. Phone/Fax

Practice location:
  • Phone: 707-797-0064
  • Fax:
Mailing address:
  • Phone: 707-797-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: WAYNE DOC R. WILSON
Title or Position: DIRECTOR
Credential: LCSW
Phone: 707-797-0064