Individual
JAKE BARTLEY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-I
Contact information
Practice address
130 VINE ST, RENO, NV 89503-5546
(775) 900-8522
Mailing address
130 VINE ST, RENO, NV 89503-5546
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
07585-I
NV
Other
Enumeration date
11/09/2020
Last updated
11/10/2023
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