Provider Demographics
NPI:1275990152
Name:BILL WILSON CENTER
Entity Type:Organization
Organization Name:BILL WILSON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - TAY MENTAL HEALTH & SLS
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:408-278-2531
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-0127
Mailing Address - Country:US
Mailing Address - Phone:707-255-3300
Mailing Address - Fax:
Practice Address - Street 1:1635 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2123
Practice Address - Country:US
Practice Address - Phone:408-278-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty