Wilson, Jeffrey Grant
Wilson, Jeffrey Grant is an sole proprietor health care provider with primary practice located at 27725 Santa Margarita Pkwy Suite 215, Mission Viejo CA 92691-6704. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Wilson, Jeffrey Grant can be contacted via phone (949) 272-3870.Contact Information
Primary practice address
27725 Santa Margarita Pkwy Suite 215
Mission Viejo CA 92691-6704
Phone: (949) 272-3870
Fax: (949) 951-2802
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY12832 | California |
Profile Details
| NPI number | 1245277979 |
|---|---|
| LBN Legal business name | Wilson, Jeffrey Grant |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 1st, 2006 |
| Last updated | Nov 21st, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245277979 | NPPES |
| California | Other | W19141A | MEDICARE GROUP ID |
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