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General NPI Number Information
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NPI Number | 1861733800
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Entity Type | Organization
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Legal Business Name | STEVIE WILSON, P.C.
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 1601 MEDICAL CENTER DR SUITE 6
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City | EDMOND
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State | OK
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Zip | 73034-6359
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Country | US
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Telephone | 405-420-1658
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Fax |
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Provider Business Mailing Address
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Address Line | 9501 S I 35 SERVICE RD 907
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City | MOORE
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State | OK
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Zip | 73160-3140
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Country | US
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Telephone | 405-420-1658
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEVIE WILSON
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Credential |
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Telephone | 405-420-1658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4859
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License Number State | OK
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