=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811038409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA WILKINSON MA, LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 01/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2743 CALIFORNIA AVE SW SUITE 301
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98116-6454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-679-4878
-----------------------------------------------------
Fax | 206-971-5072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4742 42ND AVE SW # 184
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98116-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-679-4878
-----------------------------------------------------
Fax | 206-363-9639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH00010691
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------