Provider Demographics
NPI:1952477937
Name:WILSON, KATHLEEN CRESCI (LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CRESCI
Last Name:WILSON
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MIRAMAR DR
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-5133
Mailing Address - Country:US
Mailing Address - Phone:415-425-0540
Mailing Address - Fax:650-726-9446
Practice Address - Street 1:590 MIRAMAR DR
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-5133
Practice Address - Country:US
Practice Address - Phone:415-425-0540
Practice Address - Fax:650-726-9446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist