MEDICARE: JASON WILSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1013338870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON WILSON

Provider Business Mailing Address
First Line	:	7332 VILLA DEL SOL LN
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-7330
Country	:	US
Telephone Number	:	310-702-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 HURLEY WAY STE 145
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-3231
Country	:	US
Telephone Number	:	310-702-5792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2013
Last Update Date	:	12/11/2025

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