Provider Demographics
NPI:1639372212
Name:WILSON, MELVIN R (PHD,, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHD,, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SERENDIPITY TRL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8510
Mailing Address - Country:US
Mailing Address - Phone:501-525-3023
Mailing Address - Fax:
Practice Address - Street 1:105 RESERVE ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4195
Practice Address - Country:US
Practice Address - Phone:501-624-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0411046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional