Provider Demographics
NPI:1457679409
Name:WILSON, JASON W (LPC,MASTER OF ART)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPC,MASTER OF ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 BELGOLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-1002
Mailing Address - Country:US
Mailing Address - Phone:281-807-9252
Mailing Address - Fax:281-573-8957
Practice Address - Street 1:7026 BELGOLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-1002
Practice Address - Country:US
Practice Address - Phone:281-807-9252
Practice Address - Fax:281-573-8957
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional