Healthcare Provider Details

I. General information

NPI: 1326297615
Provider Name (Legal Business Name): ZEBEDEE RHETT WILSON MA, MHP, LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 LITTLEROCK RD SW BLDG 6
TUMWATER WA
98512-7332
US

IV. Provider business mailing address

6334 LITTLEROCK RD SW BLDG 6
TUMWATER WA
98512-7332
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-7590
  • Fax: 360-704-7591
Mailing address:
  • Phone: 360-704-7590
  • Fax: 360-704-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60795964
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: