Healthcare Provider Details

I. General information

NPI: 1134698855
Provider Name (Legal Business Name): ADVANCED COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MERCHANT ST
REDDING CA
96002-0627
US

IV. Provider business mailing address

940 MERCHANT ST
REDDING CA
96002-0627
US

V. Phone/Fax

Practice location:
  • Phone: 530-605-1361
  • Fax: 530-605-1363
Mailing address:
  • Phone: 530-605-1361
  • Fax: 530-605-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BILLY LEE WILSON JR.
Title or Position: DIRECTOR
Credential: LMFT
Phone: 530-605-1361