Provider Demographics
NPI:1558515114
Name:WILSON, NANCY BISSADA (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BISSADA
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 STILLBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-6127
Mailing Address - Country:US
Mailing Address - Phone:713-591-3612
Mailing Address - Fax:
Practice Address - Street 1:4200 MONTROSE BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5444
Practice Address - Country:US
Practice Address - Phone:713-591-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional