=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801335427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIKE WILSON LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2017
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 VICTORY PARKWAY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-558-5891
-----------------------------------------------------
Fax | 513-558-5076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3250 VICTORY PARKWAY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-363-8400
-----------------------------------------------------
Fax | 513-363-8420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E.1300054
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | E.1300054-SUPV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------