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NPI Code Detail

MEDICARE: ENID WILSON LMFT

MEDICARE: ENID WILSON LMFT
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
1106H00000XMarriage & Family Therapist149114CA

General Provider Information

NPI Number : 1508588831
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENID WILSON LMFT
Provider Business Mailing Address
First Line : 2335 AMERICAN RIVER DR STE 305
Second Line :
City : SACRAMENTO
State : CA
Zip : 95825-7088
Country : US
Telephone Number : 916-990-2326
Fax Number :
Provider Business Practice Location Address
First Line : 2335 AMERICAN RIVER DR STE 305
Second Line :
City : SACRAMENTO
State : CA
Zip : 95825-7088
Country : US
Telephone Number : 916-990-2326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2022
Last Update Date : 09/22/2024

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Directions to “ ENID WILSON LMFT” Practice Location

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