Provider Demographics
NPI:1053659946
Name:WILSON, VOSIA XAN (LPC)
Entity Type:Individual
Prefix:
First Name:VOSIA
Middle Name:XAN
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 1:512 E 40TH ST N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-1512
Mailing Address - Country:US
Mailing Address - Phone:918-804-8618
Mailing Address - Fax:
Practice Address - Street 1:3606 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6447
Practice Address - Country:US
Practice Address - Phone:918-949-4212
Practice Address - Fax:918-949-4299
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255R0406X
OK7167101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind