Provider Demographics
NPI:1558565556
Name:WILSON, DAEDALYS ROBERT (LMFT)
Entity Type:Individual
Prefix:
First Name:DAEDALYS
Middle Name:ROBERT
Last Name:WILSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NOYO CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7662
Mailing Address - Country:US
Mailing Address - Phone:530-520-1333
Mailing Address - Fax:
Practice Address - Street 1:2505 VALHALLA PL STE 110
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-8276
Practice Address - Country:US
Practice Address - Phone:530-520-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist