Provider Demographics
NPI:1053062695
Name:WILSON, COURTNEY S (LPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 W BELMONT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2166
Mailing Address - Country:US
Mailing Address - Phone:312-508-3645
Mailing Address - Fax:312-971-8554
Practice Address - Street 1:1438 W BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2166
Practice Address - Country:US
Practice Address - Phone:312-508-3645
Practice Address - Fax:312-971-8554
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17801796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional