MEDICARE: GAIL WILSON, LMFT, A PROF. CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003391533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAIL WILSON, LMFT, A PROF. CORP

Provider Business Mailing Address
First Line	:	18231 TACOMA RIDGE DR
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77377-2335
Country	:	US
Telephone Number	:	510-914-6282
Fax Number	:

Provider Business Practice Location Address
First Line	:	17907 KUYKENDAHL RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8152
Country	:	US
Telephone Number	:	925-605-9127
Fax Number	:	925-397-6793

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GAIL YVONNE WILSON KAKISHITA
Credential	:	LMFT
Telephone Number	:	925-605-9127

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	10/01/2018

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