Provider Demographics
NPI:1679821003
Name:WILSON, SHERMAN A (LPA)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 N MAIN AVE
Mailing Address - Street 2:SUITE 740
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5712
Mailing Address - Country:US
Mailing Address - Phone:210-271-7411
Mailing Address - Fax:210-271-9414
Practice Address - Street 1:1222 N MAIN AVE
Practice Address - Street 2:SUITE 740
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5712
Practice Address - Country:US
Practice Address - Phone:210-271-7411
Practice Address - Fax:210-271-9414
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36310103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis