Provider Demographics
NPI:1821151226
Name:WILSON, ALICE FAITH (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:FAITH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:14515 BRIARHILLS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1034
Mailing Address - Country:US
Mailing Address - Phone:281-741-2828
Mailing Address - Fax:713-481-1643
Practice Address - Street 1:14515 BRIARHILLS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1034
Practice Address - Country:US
Practice Address - Phone:281-741-2828
Practice Address - Fax:713-741-2828
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12238 LPC106H00000X
TX12238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1130270-02Medicaid