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General NPI Number Information
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NPI Number | 1548883390
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Entity Type | Individual
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Provider Name | KRISTA WILSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 800 CUSTER AVE STE 5
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City | EVANSTON
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State | IL
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Zip | 60202-2273
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Country | US
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Telephone | 847-425-1500
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Fax | 847-972-6277
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Provider Business Mailing Address
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Address Line | 800 CUSTER AVE STE 5
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City | EVANSTON
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State | IL
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Zip | 60202-2273
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Country | US
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Telephone | 847-425-1500
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Fax | 847-972-6277
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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 | LPCC.0017610
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.016352
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.016784
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License Number State | IL
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