Basic Information
| Provider Information | |||||||||
| NPI: | 1497951966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 E VICTORIA ST | ||||||||
| Address2: | SP 173 | ||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902206016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106387915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1085 W. VICTORIA STREET | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108685379 | ||||||||
| FaxNumber: | 3108685379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.