Provider Demographics
NPI:1225193790
Name:WILSON, SHEILAH M (LPC, LISAC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SHEILAH
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC, LISAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N HUMPHREYS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3063
Mailing Address - Country:US
Mailing Address - Phone:928-779-3783
Mailing Address - Fax:928-773-1150
Practice Address - Street 1:617 N HUMPHREYS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3063
Practice Address - Country:US
Practice Address - Phone:928-779-3783
Practice Address - Fax:928-773-1150
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCC-75942101Y00000X
AZLISAC-10648101YA0400X
AZLPC-10984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7046676OtherAETNA
AZ864638Medicaid
AZ569518OtherVALUE OPTIONS