Provider Demographics
NPI:1396820122
Name:WILCOX, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WILCOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 HILLCREST RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1526
Mailing Address - Country:US
Mailing Address - Phone:972-386-8990
Mailing Address - Fax:972-386-8954
Practice Address - Street 1:12820 HILLCREST RD
Practice Address - Street 2:SUITE C127
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1526
Practice Address - Country:US
Practice Address - Phone:972-386-8990
Practice Address - Fax:972-386-8954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional