Provider Demographics
NPI:1124385109
Name:WILSON COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:WILSON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OF LLC
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:CIANCIOLO
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-637-9457
Mailing Address - Street 1:4020 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2606
Mailing Address - Country:US
Mailing Address - Phone:918-637-9457
Mailing Address - Fax:
Practice Address - Street 1:5110 S YALE AVE STE 412
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7483
Practice Address - Country:US
Practice Address - Phone:918-574-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty