Provider Demographics
NPI:1164759833
Name:WILSON, ORA (LADC)
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ORA
Other - Middle Name:LEE
Other - Last Name:GRAY-WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC
Mailing Address - Street 1:1309 NW 99TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-4907
Mailing Address - Country:US
Mailing Address - Phone:405-421-7360
Mailing Address - Fax:405-607-6671
Practice Address - Street 1:105 SE 45TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-3201
Practice Address - Country:US
Practice Address - Phone:405-632-1900
Practice Address - Fax:405-632-1976
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health