MEDICARE: ANN WILSON, PSY.D. PC

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	103TC0700X	Clinical Psychologist	36477	TX

General Provider Information

NPI Number	:	1497104103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN WILSON, PSY.D. PC

Provider Business Mailing Address
First Line	:	PO BOX 173
Second Line	:
City	:	JEROME
State	:	AZ
Zip	:	86331-0173
Country	:	US
Telephone Number	:	832-919-5732
Fax Number	:	832-583-0012

Provider Business Practice Location Address
First Line	:	2901 WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3399
Country	:	US
Telephone Number	:	713-300-0713
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANN MARIE WILSON
Credential	:	PSY.D.
Telephone Number	:	832-919-5732

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	01/18/2024

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