Provider Demographics
NPI:1710003678
Name:WILSON, JOHN ROY (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROY
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 BERRY HL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7712
Mailing Address - Country:US
Mailing Address - Phone:214-592-0680
Mailing Address - Fax:
Practice Address - Street 1:1506 N GREENVILLE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8622
Practice Address - Country:US
Practice Address - Phone:972-838-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health