Provider Demographics
NPI:1962292698
Name:WILSON, AVERY MICHELLE
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27200 TOURNEY RD STE 255
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4983
Mailing Address - Country:US
Mailing Address - Phone:661-222-9901
Mailing Address - Fax:
Practice Address - Street 1:27200 TOURNEY RD STE 255
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4983
Practice Address - Country:US
Practice Address - Phone:661-222-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst