Provider Demographics
NPI:1710002746
Name:WILSON, CHRISTINE (LCPC 19 - LMFT 34)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCPC 19 - LMFT 34
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4403
Mailing Address - Country:US
Mailing Address - Phone:208-375-2730
Mailing Address - Fax:208-658-6137
Practice Address - Street 1:3318 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4403
Practice Address - Country:US
Practice Address - Phone:208-375-2730
Practice Address - Fax:208-658-6137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 19 LMFT 34101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional