Healthcare Provider Details

I. General information

NPI: 1003391533
Provider Name (Legal Business Name): GAIL WILSON, LMFT, A PROF. CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17907 KUYKENDAHL RD
SPRING TX
77379-8152
US

IV. Provider business mailing address

18231 TACOMA RIDGE DR
TOMBALL TX
77377-2335
US

V. Phone/Fax

Practice location:
  • Phone: 925-605-9127
  • Fax: 925-397-6793
Mailing address:
  • Phone: 510-914-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. GAIL YVONNE WILSON KAKISHITA
Title or Position: OWNER
Credential: LMFT
Phone: 925-605-9127