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General NPI Number Information
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NPI Number | 1710003678
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Entity Type | Individual
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Provider Name | JOHN ROY WILSON LPC
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 1506 N GREENVILLE AVE SUITE 220
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City | ALLEN
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State | TX
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Zip | 75002-8622
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Country | US
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Telephone | 972-838-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 2612 BERRY HL
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City | MCKINNEY
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State | TX
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Zip | 75069-7712
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Country | US
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Telephone | 214-592-0680
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 16050
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License Number State | TX
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