Individual
MECHELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1720 N WESTGATE DR STE A, BOISE, ID 83704-7164
(208) 334-6916
Mailing address
PO BOX 83720, BOISE, ID 83720-0026
(208) 334-6916
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-26040
ID
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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