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General NPI Number Information
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NPI Number | 1578444378
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Entity Type | Individual
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Provider Name | KYLE IAN WILSON
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Gender | Male
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1315 FRUITVALE AVE
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City | OAKLAND
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State | CA
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Zip | 94601-2927
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Country | US
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Telephone | 833-317-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 1177 MARKET ST APT 1505
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-1846
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Country | US
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Telephone | 780-714-8748
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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