Provider Demographics
NPI:1255653010
Name:WILSON, STARLA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:ANN
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 1:2323 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2723
Mailing Address - Country:US
Mailing Address - Phone:620-421-6637
Mailing Address - Fax:620-421-6402
Practice Address - Street 1:2323 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2723
Practice Address - Country:US
Practice Address - Phone:620-421-6637
Practice Address - Fax:620-421-6402
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC2094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional