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General NPI Number Information
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NPI Number | 1316074487
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Entity Type | Individual
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Provider Name | SHANTEL JONQUEL WILSON-MCGEE M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 1303 W WALNUT PKWY
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City | COMPTON
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State | CA
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Zip | 90220-5030
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Country | US
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Telephone | 562-208-9492
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Fax | 310-868-5398
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Provider Business Mailing Address
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Address Line | 151 W FORHAN ST
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City | LONG BEACH
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State | CA
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Zip | 90805-2119
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Country | US
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Telephone | 562-428-0078
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 101395
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF88785
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License Number State | CA
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