MEDICARE: NANCY BISSADA WILSON LPC

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
1	101YP2500X	Professional Counselor	61954	TX

General Provider Information

NPI Number	:	1558515114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY BISSADA WILSON LPC

Provider Business Mailing Address
First Line	:	5627 STILLBROOKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-6127
Country	:	US
Telephone Number	:	713-591-3612
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 MONTROSE BLVD
Second Line	:	SUITE 510
City	:	HOUSTON
State	:	TX
Zip	:	77006-5444
Country	:	US
Telephone Number	:	713-591-3612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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