Provider Demographics
NPI:1639599590
Name:WILSON, COURT MARGARET
Entity Type:Individual
Prefix:
First Name:COURT
Middle Name:MARGARET
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MARGARET
Other - Last Name:PEPLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:837 CALLAHAN DR STE C
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3368
Mailing Address - Country:US
Mailing Address - Phone:360-240-0022
Mailing Address - Fax:360-240-0023
Practice Address - Street 1:837 CALLAHAN DR STE C
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3368
Practice Address - Country:US
Practice Address - Phone:360-240-0022
Practice Address - Fax:360-240-0023
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60458820103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health