=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306526587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUBREY WILSON COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2023
-----------------------------------------------------
Last Update Date | 07/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 E 7TH ST STE 3
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72653-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-288-5317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 E 7TH ST STE 3
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72653-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-288-5317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | AUBREY WILSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 740-288-5317
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------