Active NPI
Molli Marie Wilson, PHD
- Psychologist
- Covington, WA
National Provider Identifier
1639216120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY00003780
- Practice address
- 17121 SE 270TH PL
Suite 205
Covington, WA 98042 - Phone
- (425) 413-8970
- Fax
- (253) 638-7465
- NPI assigned
- Jan 31, 2007
- Last updated
- Feb 5, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY00003780 | WA | Primary |
| Clinical Social Worker | 1041C0700X | LW00005493 | WA |
Addresses
Primary practice location
17121 SE 270TH PL
Suite 205
Covington, WA 98042
Mailing address
PO Box 402
Maple Valley, WA 98038
Phone (425) 413-8970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00003780 | WA | MD | Psychologist |
| LW00005493 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265328000000",
"number": "1639216120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 402",
"city": "MAPLE VALLEY",
"state": "WA",
"postal_code": "98038",
"telephone_number": "425-413-8970",
"fax_number": "253-638-7465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17121 SE 270TH PL",
"address_2": "SUITE 205",
"city": "COVINGTON",
"state": "WA",
"postal_code": "98042",
"telephone_number": "425-413-8970",
"fax_number": "253-638-7465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MOLLI",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2010-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY00003780",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW00005493",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covington, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.