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General NPI Number Information
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NPI Number | 1063051308
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Entity Type | Individual
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Provider Name | KELLY SEVIN WILSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 2301 ELDORADO PKWY STE 150
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City | MCKINNEY
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State | TX
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Zip | 75070-1856
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Country | US
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Telephone | 469-215-0314
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Fax | 469-701-0909
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Provider Business Mailing Address
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Address Line | 6941 POPLAR WOOD TRL
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City | KNOXVILLE
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State | TN
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Zip | 37920-6484
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Country | US
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Telephone | 239-896-4842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202509
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License Number State | TX
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