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General NPI Number Information
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NPI Number | 1679063473
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Entity Type | Individual
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Provider Name | LYNN M WILSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 252 W 17TH PL
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City | TULSA
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State | OK
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Zip | 74119-4654
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Country | US
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Telephone | 918-382-2470
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Fax | 918-585-9543
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Provider Business Mailing Address
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Address Line | 252 W 17TH PL
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City | TULSA
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State | OK
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Zip | 74119-4654
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Country | US
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Telephone | 918-382-2470
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Fax | 918-585-9543
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 5971
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License Number State | OK
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