| Doctor Name: | MR. RICHARD LEO WILSON |
| NPI Number: | 1003882705 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC |
| License Number: | LH00007082 |
| Business Practice Address: | 104 S Freya St Ste 215b Orange Flag Bldg Spokane, WA - 99202 |
| Business Phone Number: | 5095352048 |
| Business Fax Number: | 5095352046 |
| Mailing Address: | 122 N Raymond Rd, Ste 20 SPOKANE VALLEY |
| State: | WA |
| Postal Code: | 992066832 |
| Phone Number: | 5099261770 |
| Fax Number: | 5092289542 |
| NPI Enumeration Date: | 02/23/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LH00007082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |