Provider Demographics
NPI:1649640921
Name:WILSON COUNSELING, LLC
Entity type:Organization
Organization Name:WILSON COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-904-1072
Mailing Address - Street 1:1312 WESTEN ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3352
Mailing Address - Country:US
Mailing Address - Phone:270-904-1072
Mailing Address - Fax:270-904-1073
Practice Address - Street 1:1312 WESTEN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3352
Practice Address - Country:US
Practice Address - Phone:270-904-1072
Practice Address - Fax:270-904-1073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-30
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100300070Medicaid
KYK139910Medicare PIN