Provider Demographics
NPI:1235683145
Name:WILSON, BENJAMIN (LMHC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 E 148TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4360
Mailing Address - Country:US
Mailing Address - Phone:317-587-0500
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:17840 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5409
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002965A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health