Provider Demographics
NPI:1376574095
Name:WILSON, LINDSAY EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:EDWARD
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5124
Mailing Address - Country:US
Mailing Address - Phone:727-323-2899
Mailing Address - Fax:727-327-3515
Practice Address - Street 1:5401 22ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5124
Practice Address - Country:US
Practice Address - Phone:727-323-2899
Practice Address - Fax:727-327-3515
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health