Provider Demographics
NPI:1003391533
Name:GAIL WILSON, LMFT, A PROF. CORP
Entity Type:Organization
Organization Name:GAIL WILSON, LMFT, A PROF. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:YVONNE WILSON
Authorized Official - Last Name:KAKISHITA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:925-605-9127
Mailing Address - Street 1:18231 TACOMA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2335
Mailing Address - Country:US
Mailing Address - Phone:510-914-6282
Mailing Address - Fax:
Practice Address - Street 1:17907 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8152
Practice Address - Country:US
Practice Address - Phone:925-605-9127
Practice Address - Fax:925-397-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356542724Medicaid