Provider Demographics
NPI:1891430666
Name:WILSON, MAILA ELISA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAILA
Middle Name:ELISA
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 REAL WAY LN
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3016
Mailing Address - Country:US
Mailing Address - Phone:619-602-3464
Mailing Address - Fax:
Practice Address - Street 1:1399 REAL WAY LN
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3016
Practice Address - Country:US
Practice Address - Phone:619-602-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health