Provider Demographics
NPI:1376040071
Name:WILSON, JUDY NELL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:NELL
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 WINDHAVEN PKWY APT 15102
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6110
Mailing Address - Country:US
Mailing Address - Phone:972-754-0313
Mailing Address - Fax:
Practice Address - Street 1:12959 JUPITER RD STE 254
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5250
Practice Address - Country:US
Practice Address - Phone:214-221-0132
Practice Address - Fax:214-221-0242
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional