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General NPI Number Information
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NPI Number | 1932717584
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Entity Type | Individual
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Provider Name | KAREN WILSON
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 2431 W HORIZON RIDGE PKWY STE 110
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City | HENDERSON
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State | NV
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Zip | 89052-5783
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Country | US
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Telephone | 408-975-2730
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MOORPARK AVE STE 300
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City | SAN JOSE
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State | CA
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Zip | 95128-2680
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Country | US
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Telephone | 408-975-2730
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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 | MI4070
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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