MEDICARE: YVONNE 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
1	101YP2500X	Professional Counselor	6401011576	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831475680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE WILSON LPC

Provider Business Mailing Address
First Line	:	38902 HOUSTON DR
Second Line	:
City	:	ROMULUS
State	:	MI
Zip	:	48174-5052
Country	:	US
Telephone Number	:	313-333-0916
Fax Number	:

Provider Business Practice Location Address
First Line	:	20500 EUREKA RD
Second Line	:
City	:	TAYLOR
State	:	MI
Zip	:	48180-6332
Country	:	US
Telephone Number	:	734-285-8282
Fax Number	:

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	02/26/2019

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