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General NPI Number Information
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NPI Number | 1134698855
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Entity Type | Organization
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Legal Business Name | ADVANCED COUNSELING INC
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 940 MERCHANT ST
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City | REDDING
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State | CA
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Zip | 96002-0627
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Country | US
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Telephone | 530-605-1361
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Fax | 530-605-1363
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Provider Business Mailing Address
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Address Line | 940 MERCHANT ST
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City | REDDING
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State | CA
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Zip | 96002-0627
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Country | US
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Telephone | 530-605-1361
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Fax | 530-605-1363
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. BILLY LEE WILSON JR.
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Credential | LMFT
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Telephone | 530-605-1361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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