Myrick J Wilson Jr.

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1788 Celeste Ave
Clovis, CA 93611-2069

Phone

(559) 243-7002

NPI assigned

Sep 9, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kyjo Enterprises, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Clovis, CA
  • NPI 1356933857
  NPD
• Kyjo Enterprises, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
  • NPI 1407448905
  NPD (past)
• Kyjo Enterprises, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
  • NPI 1831781343
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1073234787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1826 S DELNO AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937063550",
            "telephone_number": "559-307-2765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1788 CELESTE AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936112069",
            "telephone_number": "559-243-7002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2291 N Hazel Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937225562",
            "country_code": "US",
            "telephone_number": "559-243-7002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3138 W Barstow Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937112603",
            "country_code": "US",
            "telephone_number": "559-243-7002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MYRICK",
        "middle_name": "J",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willow Creek Healthcare Center, LLC (Willow Creek Healthcare Center)
• Willow Creek Post Acute, LLC (Willow Creek Healthcare Center)
• Aereyon Wilson
• Emily Rose Wilson, BCAT
• Jordyn L'Nae Wilson
• Rebekah Anne Wilson, LMFT
• William M Wilson, MD
• Amy Winchester, DC
• Kevin Wingert, M.D.
• Alan Bruce Winter, D.D.S.

• Counselor in Clovis, CA
• Providers in Clovis, CA by specialty
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.