Provider Demographics
NPI:1619681152
Name:BRADLEY T WILSON FAMILY COUNSELING INC
Entity Type:Organization
Organization Name:BRADLEY T WILSON FAMILY COUNSELING INC
Other - Org Name:THE OCD TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-253-4537
Mailing Address - Street 1:1451 QUAIL ST STE 112
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2742
Mailing Address - Country:US
Mailing Address - Phone:714-253-4537
Mailing Address - Fax:949-470-2642
Practice Address - Street 1:1451 QUAIL ST STE 112
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2742
Practice Address - Country:US
Practice Address - Phone:714-253-4537
Practice Address - Fax:949-470-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty