Provider Demographics
NPI:1932265188
Name:WILSON, BILLY LEE JR (MA , LMFT)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:LEE
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MA , LMFT
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Mailing Address - Street 1:20867 OLD ALTURAS RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-7608
Mailing Address - Country:US
Mailing Address - Phone:530-945-2192
Mailing Address - Fax:530-605-1363
Practice Address - Street 1:940 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0627
Practice Address - Country:US
Practice Address - Phone:530-945-2192
Practice Address - Fax:530-605-1363
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAMFC43963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist