Individual
MARY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 E BASIN AVE, PAHRUMP, NV 89060-4611
(775) 910-1736
Mailing address
780 E COUNTRY PLACE RD, PAHRUMP, NV 89060-1705
(775) 910-1736
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C10404
NV
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
08/03/2011
Last updated
02/05/2019
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