Provider Demographics
NPI:1134356199
Name:WLSON, RICHARD EARL II (ED D)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EARL
Last Name:WLSON
Suffix:II
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4813
Mailing Address - Country:US
Mailing Address - Phone:713-884-0884
Mailing Address - Fax:713-583-5877
Practice Address - Street 1:4112 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4813
Practice Address - Country:US
Practice Address - Phone:713-884-0884
Practice Address - Fax:713-583-5877
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147509701Medicaid
1740421171OtherNPI
TX1902948326OtherNPI
TX1154563419OtherNPI
TX1154563419OtherNPI