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General NPI Number Information
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NPI Number | 1538757703
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Entity Type | Organization
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Legal Business Name | WILSON FAMILY COUNSELING SERVICES
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 123 SYCAMORE AVE STE 103
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City | MANTECA
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State | CA
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Zip | 95336-4569
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Country | US
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Telephone | 120-974-0994
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Fax | 209-707-3538
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Provider Business Mailing Address
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Address Line | 123 SYCAMORE AVE STE 103
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City | MANTECA
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State | CA
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Zip | 95336-4569
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Country | US
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Telephone | 122-097-4099
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Fax | 209-707-3538
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Authorized Official
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Title or Position | DIRECTOR/CLINICAL SUPERVISOR
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Name | KATHLEEN WILSON-PARISH
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Credential | LMFT
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Telephone | 209-740-9943
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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 |
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License Number State |
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