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NPI Code Detail

MEDICARE: DR. RICHARD EARL WLSON II ED. D

MEDICARE: DR. RICHARD EARL WLSON II ED. D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
3171W00000XContractor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21740421171OTHERNPI
31902948326OTHERTXNPI
41154563419OTHERTXNPI

General Provider Information

NPI Number : 1134356199
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD EARL WLSON II ED. D
Provider Business Mailing Address
First Line : 4112 AUSTIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77004-4813
Country : US
Telephone Number : 713-884-0884
Fax Number : 713-583-5877
Provider Business Practice Location Address
First Line : 4112 AUSTIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77004-4813
Country : US
Telephone Number : 713-884-0884
Fax Number : 713-583-5877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2009
Last Update Date : 03/07/2023

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