Provider Demographics
NPI:1801166772
Name:WILSON, CAROL (MED, LPC-S)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 I ST NE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-4931
Mailing Address - Country:US
Mailing Address - Phone:918-541-6210
Mailing Address - Fax:918-542-6330
Practice Address - Street 1:532 I ST NE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-4931
Practice Address - Country:US
Practice Address - Phone:918-541-6210
Practice Address - Fax:918-542-6330
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional