Provider Demographics
NPI:1598906901
Name:WILSON, JUDY CHRISTINE (CNS, LADC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:CHRISTINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 E. 41ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-3215
Mailing Address - Country:US
Mailing Address - Phone:918-621-1600
Mailing Address - Fax:918-828-0155
Practice Address - Street 1:7950 E. 41ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-3215
Practice Address - Country:US
Practice Address - Phone:918-621-1600
Practice Address - Fax:918-621-1600
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85101YA0400X
OKR0049260364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)