MEDICARE: MS. KATHE GOLDBECK WILSON MA, MFT

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	106H00000X	Marriage & Family Therapist	MFC 47680	CA

General Provider Information

NPI Number	:	1073840716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHE GOLDBECK WILSON MA, MFT

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	WEIMAR
State	:	CA
Zip	:	95736-0051
Country	:	US
Telephone Number	:	530-613-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 ROUGH AND READY HILL RD
Second Line	:
City	:	COLFAX
State	:	CA
Zip	:	95713-9502
Country	:	US
Telephone Number	:	530-613-0801
Fax Number	:

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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