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NPI Code Detail

MEDICARE: DR. FREDERICK ROBERT WILSON PH.D., LPCC-S

MEDICARE: DR. FREDERICK ROBERT WILSON PH.D., LPCC-S
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 CounselorE261-SOH

General Provider Information

NPI Number : 1730387903
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDERICK ROBERT WILSON PH.D., LPCC-S
Provider Business Mailing Address
First Line : 5718 YAMASSEE DR
Second Line :
City : LIBERTY TWP
State : OH
Zip : 45011-8465
Country : US
Telephone Number : 513-205-5738
Fax Number :
Provider Business Practice Location Address
First Line : 2347 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-1745
Country : US
Telephone Number : 513-357-4602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2007
Last Update Date : 12/05/2016

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