Provider Demographics
NPI:1164280830
Name:CURTIS, WILSON (CRAADC)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:CURTIS
Suffix:
Gender:M
Credentials:CRAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SE WINDSTAR CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3162
Mailing Address - Country:US
Mailing Address - Phone:816-808-0835
Mailing Address - Fax:
Practice Address - Street 1:1004 SE WINDSTAR CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3162
Practice Address - Country:US
Practice Address - Phone:816-808-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
8434101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health