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General NPI Number Information
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NPI Number | 1134356199
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Entity Type | Individual
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Provider Name | RICHARD EARL WLSON II ED. D
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Gender | Male
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4112 AUSTIN ST
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City | HOUSTON
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State | TX
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Zip | 77004-4813
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Country | US
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Telephone | 713-884-0884
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Fax | 713-583-5877
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Provider Business Mailing Address
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Address Line | 4112 AUSTIN ST
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City | HOUSTON
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State | TX
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Zip | 77004-4813
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Country | US
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Telephone | 713-884-0884
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Fax | 713-583-5877
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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