Individual
MR. BRADLEY THOMAS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
18430 BROOKHURST ST STE 202A, FOUNTAIN VALLEY, CA 92708-6758
(714) 253-4537
Mailing address
18430 BROOKHURST ST STE 202A, FOUNTAIN VALLEY, CA 92708-6758
(714) 253-4537
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
130605
CA
261QM0850X
Adult Mental Health Clinic/Center
130605
CA
Other
Enumeration date
01/17/2022
Last updated
04/25/2022
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