Provider Demographics
NPI:1285326462
Name:WILSON MARRIAGE AND FAMILY THERAPY PC
Entity type:Organization
Organization Name:WILSON MARRIAGE AND FAMILY THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-404-5692
Mailing Address - Street 1:4653 CARMEL MOUNTAIN RD STE 308-120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6650
Mailing Address - Country:US
Mailing Address - Phone:619-404-5692
Mailing Address - Fax:
Practice Address - Street 1:5229 BRICKFIELD LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6948
Practice Address - Country:US
Practice Address - Phone:619-404-5692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty