Healthcare Provider Details

I. General information

NPI: 1598906901
Provider Name (Legal Business Name): JUDY CHRISTINE WILSON CNS, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 E. 41ST
TULSA OK
74145-3215
US

IV. Provider business mailing address

7950 E. 41ST
TULSA OK
74145-3215
US

V. Phone/Fax

Practice location:
  • Phone: 918-621-1600
  • Fax: 918-621-1600
Mailing address:
  • Phone: 918-621-1600
  • Fax: 918-828-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number85
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR0049260
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: