=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003391533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAIL WILSON, LMFT, A PROF. CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2018
-----------------------------------------------------
Last Update Date | 10/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17907 KUYKENDAHL RD
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-8152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-605-9127
-----------------------------------------------------
Fax | 925-397-6793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18231 TACOMA RIDGE DR
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77377-2335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-914-6282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. GAIL YVONNE WILSON KAKISHITA
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 925-605-9127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------