Provider Demographics
NPI:1932571106
Name:WILSON, BRIANA (MFT TRAINEE)
Entity Type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2146
Mailing Address - Country:US
Mailing Address - Phone:951-845-3588
Mailing Address - Fax:
Practice Address - Street 1:25190 HANCOCK AVE
Practice Address - Street 2:SUITE #D
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5947
Practice Address - Country:US
Practice Address - Phone:951-239-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist