Individual
MR. JOSEPH CARROLL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.W.,L.C.S.W.
Contact information
Practice address
200 FOREST ST., MCCALL, ID 83638
(208) 634-2899
(208) 634-2564
Mailing address
P.O. BOX 2430, MCCALL, ID 83638
(208) 634-2899
(208) 634-2564
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
M.S.W.,L.C.S.W 900
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L9024
BLUE CROSS
ID
01
—
REGENCE/BLUE SHIELD
000010017445
ID
Enumeration date
10/05/2006
Last updated
07/08/2007
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