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NPI Code Detail

MEDICARE: GILLIAN LAUREN WILSON LCMHC

MEDICARE: GILLIAN LAUREN WILSON LCMHC
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
1101Y00000XCounselor12664NC
2101YM0800XMental Health Counselor12664NC
3101YP2500XProfessional Counselor12664NC
4101YM0800XMental Health CounselorTPMC3042FL

General Provider Information

NPI Number : 1518363621
Entity Type Code : Individual
Provider Name (Legal Business Name) : GILLIAN LAUREN WILSON LCMHC
Provider Business Mailing Address
First Line : 119 MANDOLIN DR
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-3581
Country : US
Telephone Number : 888-214-2144
Fax Number : 866-693-2298
Provider Business Practice Location Address
First Line : 4625 E BAY DR STE 103
Second Line :
City : CLEARWATER
State : FL
Zip : 33764-6866
Country : US
Telephone Number : 888-214-2144
Fax Number : 866-693-2298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2014
Last Update Date : 05/22/2026

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