Provider Demographics
NPI:1073840716
Name:WILSON, KATHE GOLDBECK (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHE
Middle Name:GOLDBECK
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0051
Mailing Address - Country:US
Mailing Address - Phone:530-613-0801
Mailing Address - Fax:
Practice Address - Street 1:1110 ROUGH AND READY HILL RD
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-9502
Practice Address - Country:US
Practice Address - Phone:530-613-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist