Provider Demographics
NPI:1578879995
Name:OVALLES-WILSON, KEILA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KEILA
Middle Name:
Last Name:OVALLES-WILSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 PARADISE RD
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1356
Mailing Address - Country:US
Mailing Address - Phone:781-228-1093
Mailing Address - Fax:
Practice Address - Street 1:12 METHUEN ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1700
Practice Address - Country:US
Practice Address - Phone:978-683-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health