Healthcare Provider Details

I. General information

NPI: 1447244611
Provider Name (Legal Business Name): JANET LYNN WILSON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9968 HIBERT ST SUITE 101
SAN DIEGO CA
92131-1035
US

IV. Provider business mailing address

9968 HIBERT ST SUITE 101
SAN DIEGO CA
92131-1035
US

V. Phone/Fax

Practice location:
  • Phone: 760-445-4967
  • Fax: 619-956-0153
Mailing address:
  • Phone: 760-445-4967
  • Fax: 619-956-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010693
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: