Provider Demographics
NPI:1275656332
Name:RICHARD A WILSON MA
Entity Type:Organization
Organization Name:RICHARD A WILSON MA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-535-2048
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 STE 215B
Practice Address - Street 2:ORANGE FLAG BLGD
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-6204
Practice Address - Country:US
Practice Address - Phone:509-535-2048
Practice Address - Fax:509-535-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty