Provider Demographics
NPI:1003673062
Name:WILSON, CLINT (MSW)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 S 50 E
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-8011
Mailing Address - Country:US
Mailing Address - Phone:260-563-1158
Mailing Address - Fax:
Practice Address - Street 1:5233 S 50 E
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-8011
Practice Address - Country:US
Practice Address - Phone:260-563-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health