Provider Demographics
NPI:1003882705
Name:WILSON, RICHARD LEO (LMHC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEO
Last Name:WILSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:122 N RAYMOND RD
Mailing Address - Street 2:STE 20
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6832
Mailing Address - Country:US
Mailing Address - Phone:509-926-1770
Mailing Address - Fax:509-228-9542
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:STE 215B ORANGE FLAG BLDG
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-535-2048
Practice Address - Fax:509-535-2046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health