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NPI Code Detail

MEDICARE: MS. CINDY SUE WILSON LPC

MEDICARE: MS. CINDY SUE WILSON LPC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1710951421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CINDY SUE WILSON LPC
Provider Business Mailing Address
First Line : 815 E GROVERS AVE UNIT 63
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-1923
Country : US
Telephone Number : 480-234-3402
Fax Number : 480-922-5445
Provider Business Practice Location Address
First Line : 11811 N TATUM BLVD STE 3031
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-1621
Country : US
Telephone Number : 480-234-3402
Fax Number : 480-781-4522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 05/27/2020

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