Provider Demographics
NPI:1912356023
Name:WILSON, HEIDI ANN (LPCC-S)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:FARLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:419-225-8878
Practice Address - Street 1:405 WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2381
Practice Address - Country:US
Practice Address - Phone:567-318-3900
Practice Address - Fax:419-225-8878
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1300415101YP2500X
OHE.0800057-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty