Provider Demographics
NPI:1457133589
Name:FULFILLING LIFE'S PURPOSE
Entity Type:Organization
Organization Name:FULFILLING LIFE'S PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:DAEDALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-855-0553
Mailing Address - Street 1:2105 FOREST AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7695
Mailing Address - Country:US
Mailing Address - Phone:530-855-0553
Mailing Address - Fax:
Practice Address - Street 1:2105 FOREST AVE STE 120
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7695
Practice Address - Country:US
Practice Address - Phone:530-855-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty