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NPI Code Detail

MEDICARE: JANON WILSON LMSW

MEDICARE: JANON WILSON LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1235358490
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANON WILSON LMSW
Provider Business Mailing Address
First Line : PO BOX 753452
Second Line :
City : MEMPHIS
State : TN
Zip : 38175-3452
Country : US
Telephone Number : 901-375-1614
Fax Number :
Provider Business Practice Location Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2007
Last Update Date : 05/14/2011

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Directions to “ JANON WILSON LMSW” Practice Location

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