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General NPI Number Information
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NPI Number | 1932604055
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Entity Type | Individual
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Provider Name | BRYCE HAMILTON WILSON LPC
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 1825 FORTVIEW RD STE 112G
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City | AUSTIN
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State | TX
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Zip | 78704-7658
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Country | US
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Telephone | 512-630-0821
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 FORTVIEW RD STE 112G
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City | AUSTIN
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State | TX
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Zip | 78704-7658
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Country | US
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Telephone | 512-630-0821
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69705
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License Number State | TX
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