Provider Demographics
NPI:1982159489
Name:WILSON, PATRCIA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:PATRCIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1002A N SPRINGBROOK RD STE 314
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2024
Mailing Address - Country:US
Mailing Address - Phone:971-412-0452
Mailing Address - Fax:971-231-0235
Practice Address - Street 1:200 E FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-9039
Practice Address - Country:US
Practice Address - Phone:971-412-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist