Provider Demographics
NPI:1962840413
Name:WILSON, KATHERINE JANELLE (MFT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JANELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1202
Mailing Address - Country:US
Mailing Address - Phone:408-966-3312
Mailing Address - Fax:
Practice Address - Street 1:4320 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1202
Practice Address - Country:US
Practice Address - Phone:408-966-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist