Provider Demographics
NPI:1689813875
Name:BILL WILSON CENTER
Entity Type:Organization
Organization Name:BILL WILSON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-243-0222
Mailing Address - Street 1:1671 THE ALAMEDA #201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126
Mailing Address - Country:US
Mailing Address - Phone:408-243-0222
Mailing Address - Fax:
Practice Address - Street 1:1671 THE ALAMEDA #201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-243-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty