Provider Demographics
NPI:1235477738
Name:WILSON, VICKY M (LPC)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:M
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 1:501 E 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5043
Mailing Address - Country:US
Mailing Address - Phone:405-285-9880
Mailing Address - Fax:405-285-9877
Practice Address - Street 1:501 E 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5043
Practice Address - Country:US
Practice Address - Phone:405-285-9880
Practice Address - Fax:405-285-9877
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor