Provider Demographics
NPI:1922212570
Name:WILSON, PRISCILLA A (MS, LMHP)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E MILITARY AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5477
Mailing Address - Country:US
Mailing Address - Phone:402-720-5129
Mailing Address - Fax:402-721-0245
Practice Address - Street 1:1835 E MILITARY AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5477
Practice Address - Country:US
Practice Address - Phone:402-720-5129
Practice Address - Fax:402-721-0245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health