Provider Demographics
NPI:1407425119
Name:MILTON, WANDA CAROLYN (LPC, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:CAROLYN
Last Name:MILTON
Suffix:
Gender:F
Credentials:LPC, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 PARKCREST DRIVE, ABILENE, TX 79605
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5024
Mailing Address - Country:US
Mailing Address - Phone:325-665-7934
Mailing Address - Fax:
Practice Address - Street 1:3309 PARKCREST DRIVE, ABILENE, TX 79605
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5024
Practice Address - Country:US
Practice Address - Phone:325-665-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional