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General NPI Number Information
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NPI Number | 1285809392
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Entity Type | Individual
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Provider Name | RONALD TERRY WILSON PSYD, LCAC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 104 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-3131
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Country | US
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Telephone | 270-454-4558
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Fax |
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Provider Business Mailing Address
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Address Line | 104 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-3131
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Country | US
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Telephone | 270-454-4558
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 39001951A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000390A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 168501
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 39001951A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3900195AA
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License Number State | IN
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39001951A
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License Number State | IN
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Taxonomy #7
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 964686
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License Number State |
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Taxonomy #8
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001731A
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License Number State | IN
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Taxonomy #9
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31505
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License Number State | CA
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