Provider Demographics
NPI:1508107970
Name:WILSON, MILO ARTEMIS
Entity Type:Individual
Prefix:MR
First Name:MILO
Middle Name:ARTEMIS
Last Name:WILSON
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 1:8051 N CLASSEN BLVD
Mailing Address - Street 2:SUITE-F
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2152
Mailing Address - Country:US
Mailing Address - Phone:405-503-6814
Mailing Address - Fax:405-842-8846
Practice Address - Street 1:8051 N CLASSEN BLVD
Practice Address - Street 2:SUITE-F
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2152
Practice Address - Country:US
Practice Address - Phone:405-503-6814
Practice Address - Fax:405-842-8846
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor