Provider Demographics
NPI:1255870341
Name:WILSON, PATRICIA KRISTEN (QMHA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KRISTEN
Last Name:WILSON
Suffix:
Gender:F
Credentials:QMHA
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 2370
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0176
Mailing Address - Country:US
Mailing Address - Phone:501-247-8244
Mailing Address - Fax:
Practice Address - Street 1:51 SW LEE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3823
Practice Address - Country:US
Practice Address - Phone:541-265-0581
Practice Address - Fax:541-574-6252
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health