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General NPI Number Information
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NPI Number | 1215780598
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Entity Type | Individual
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Provider Name | JESSICA FAYE WILSON AMFT
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Gender | Female
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 127 JEWELL ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-1717
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Country | US
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Telephone | 650-814-9819
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Fax |
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Provider Business Mailing Address
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Address Line | 16861 PLACER OAKS RD
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City | LOS GATOS
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State | CA
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Zip | 95032-3445
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Country | US
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Telephone | 650-814-9819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 145995
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License Number State | CA
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