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Individual

AUTUMN LYNNE WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LPCC

Contact information

Practice address
1884 MAHOGANY ST, MORA, MN 55051-7111
(320) 339-9963
Mailing address
7145 375TH AVE NW, DALBO, MN 55017-8403
(763) 567-3875

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5036
MN

Other

Enumeration date
06/09/2025
Last updated
06/09/2025
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