Healthcare Provider Details

I. General information

NPI: 1982159489
Provider Name (Legal Business Name): PATRCIA WILSON MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRISHA WILSON MA, LMFT

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E FOOTHILLS DR
NEWBERG OR
97132-9039
US

IV. Provider business mailing address

1002A N SPRINGBROOK RD STE 314
NEWBERG OR
97132-2024
US

V. Phone/Fax

Practice location:
  • Phone: 971-412-4052
  • Fax:
Mailing address:
  • Phone: 971-412-0452
  • Fax: 971-231-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2401
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: