Individual
MICHAEL LAWRENCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
709 NW EVERETT ST, PORTLAND, OR 97209-3517
(503) 226-4060
(503) 445-4913
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
(503) 294-4321
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
L6028
OR
101YM0800X
Mental Health Counselor
L6028
OR
1041C0700X
Clinical Social Worker
L6028
OR
Other
Enumeration date
02/13/2015
Last updated
02/18/2015
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