Provider Demographics
NPI:1457364093
Name:WILSON, CHERYL A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 E 31ST ST STE 104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2443
Mailing Address - Country:US
Mailing Address - Phone:918-798-2187
Mailing Address - Fax:918-298-6290
Practice Address - Street 1:3227 E 31ST ST STE 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2443
Practice Address - Country:US
Practice Address - Phone:918-798-2187
Practice Address - Fax:918-298-6290
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical