Provider Demographics
NPI:1538757703
Name:WILSON FAMILY COUNSELING SERVICES
Entity type:Organization
Organization Name:WILSON FAMILY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-740-9943
Mailing Address - Street 1:123 SYCAMORE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4569
Mailing Address - Country:US
Mailing Address - Phone:122-097-4099
Mailing Address - Fax:209-707-3538
Practice Address - Street 1:123 SYCAMORE AVE STE 103
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4569
Practice Address - Country:US
Practice Address - Phone:120-974-0994
Practice Address - Fax:209-707-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty