Provider Demographics
NPI:1801832365
Name:DR. DENNIS W. WILSON
Entity Type:Organization
Organization Name:DR. DENNIS W. WILSON
Other - Org Name:COMPREHENSIVE MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:731-431-0609
Mailing Address - Street 1:1784 W NORTHFIELD BLVD
Mailing Address - Street 2:#306
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1702
Mailing Address - Country:US
Mailing Address - Phone:731-431-0609
Mailing Address - Fax:731-426-1040
Practice Address - Street 1:1784 W NORTHFIELD BLVD
Practice Address - Street 2:#306
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37219-1702
Practice Address - Country:US
Practice Address - Phone:731-431-0609
Practice Address - Fax:731-426-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733574Medicaid
TN3733574Medicaid