Provider Demographics
NPI:1275058232
Name:WILSON, LINDSAY ALYN
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ALYN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 EDWARDS
Mailing Address - Street 2:
Mailing Address - City:MERKEL
Mailing Address - State:TX
Mailing Address - Zip Code:79536-3803
Mailing Address - Country:US
Mailing Address - Phone:325-928-0014
Mailing Address - Fax:
Practice Address - Street 1:217 EDWARDS
Practice Address - Street 2:
Practice Address - City:MERKEL
Practice Address - State:TX
Practice Address - Zip Code:79536-3803
Practice Address - Country:US
Practice Address - Phone:325-928-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health