Provider Demographics
NPI:1447244611
Name:WILSON, JANET LYNN (MFT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9968 HIBERT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1035
Mailing Address - Country:US
Mailing Address - Phone:760-445-4967
Mailing Address - Fax:619-956-0153
Practice Address - Street 1:9968 HIBERT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1035
Practice Address - Country:US
Practice Address - Phone:760-445-4967
Practice Address - Fax:619-956-0153
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010693103T00000X
CAMFC40413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist