MEDICARE: JOYCE WILKERSON LPC, SPE, CSC, RPT-S

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	2001025448	MO

General Provider Information

NPI Number	:	1689883126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE WILKERSON LPC, SPE, CSC, RPT-S

Provider Business Mailing Address
First Line	:	1807 AVONDALE AVE
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-9642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 AVONDALE AVE
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-9642
Country	:	US
Telephone Number	:	417-439-7472
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/26/2013

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