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General NPI Number Information
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NPI Number | 1679907984
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Entity Type | Individual
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Provider Name | BRYAN WILSON ED.D., NCSP, BC-TMH
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Gender | Male
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 200 PUTNAM ST STE 410
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City | MARIETTA
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State | OH
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Zip | 45750-3009
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Country | US
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Telephone | 740-401-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 1648 GREATHOUSE RD
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City | WILLIAMSTOWN
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State | WV
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Zip | 26187-8400
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Country | US
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Telephone | 304-550-7523
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | N3R136200287
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SP.00685
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License Number State | OH
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