MEDICARE: ANTONIO M 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	251B00000X	Case Management Agency
2	101YP2500X	Professional Counselor	93275	TX
3	171M00000X	Case Manager/Care Coordinator
4	101YM0800X	Mental Health Counselor	93275	TX

General Provider Information

NPI Number	:	1871066787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO M WILSON LPC

Provider Business Mailing Address
First Line	:	1810 MAIN ST APT 707
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-7887
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3423 WUTHERING HEIGHTS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4552
Country	:	US
Telephone Number	:	318-676-9403
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/15/2026

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Directions to “ ANTONIO M WILSON LPC” Practice Location

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