MEDICARE: MS. KATIE WILSON LMHC

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	101Y00000X	Counselor	LCPC-5367	ID
2	101YM0800X	Mental Health Counselor	5367	ID
3	101YM0800X	Mental Health Counselor	LCPC-5367	ID
4	101YP2500X	Professional Counselor	LCPC-5367	ID
5	101YM0800X	Mental Health Counselor	LH61587780	WA

General Provider Information

NPI Number	:	1578738308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIE WILSON LMHC

Provider Business Mailing Address
First Line	:	1421 S COLEMAN RD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99212-5103
Country	:	US
Telephone Number	:	208-714-1469
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W NORTH RIVER DR STE 301
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2262
Country	:	US
Telephone Number	:	208-714-1469
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	10/30/2024

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