Healthcare Provider Details

I. General information

NPI: 1952019242
Provider Name (Legal Business Name): SHERICE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 201
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

98 E LAKE MEAD PKWY STE 201
HENDERSON NV
89015-6443
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-3038
  • Fax:
Mailing address:
  • Phone: 702-433-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: