MEDICARE: MR. MICHAEL EARL WILSON MED COUNSELING

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
1	101YP2500X	Professional Counselor	15454	TX

General Provider Information

NPI Number	:	1336390285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EARL WILSON MED COUNSELING

Provider Business Mailing Address
First Line	:	31915 DEBBI LN
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77355-4046
Country	:	US
Telephone Number	:	281-744-6106
Fax Number	:

Provider Business Practice Location Address
First Line	:	25325 BOROUGH PARK DR
Second Line	:	SUITE 220
City	:	SPRING
State	:	TX
Zip	:	77380-3569
Country	:	US
Telephone Number	:	281-744-6106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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