Provider Demographics
NPI:1992575930
Name:WILSON, JAVON J (BT)
Entity type:Individual
Prefix:
First Name:JAVON
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:JAVON
Other - Middle Name:J
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BT
Mailing Address - Street 1:18311 BOTHELL EVERETT HWY STE 180&260
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5233
Mailing Address - Country:US
Mailing Address - Phone:206-250-9014
Mailing Address - Fax:
Practice Address - Street 1:18311 BOTHELL-EVERETT HIGHWAY
Practice Address - Street 2:SUITES 180 & 280
Practice Address - City:98012, BOTHELL, WA
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:206-250-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst