MEDICARE: MS. LYN 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	101YM0800X	Mental Health Counselor	1276466004	UT
2	101YP2500X	Professional Counselor	6848	NC

General Provider Information

NPI Number	:	1710967161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYN WILSON LPC

Provider Business Mailing Address
First Line	:	1020 S MAIN ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-3176
Country	:	US
Telephone Number	:	801-538-2057
Fax Number	:	801-974-7767

Provider Business Practice Location Address
First Line	:	3148 S 1100 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3304
Country	:	US
Telephone Number	:	801-974-7740
Fax Number	:	801-974-7767

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	04/04/2012

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