Provider Demographics
NPI:1811100597
Name:EMILY ENGELLAND WILSON, PLLC
Entity type:Organization
Organization Name:EMILY ENGELLAND WILSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ENGELLAND
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-302-2467
Mailing Address - Street 1:2828 1ST AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-522-1133
Mailing Address - Fax:304-522-1134
Practice Address - Street 1:2828 1ST AVE STE 203
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-522-1133
Practice Address - Fax:304-522-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103T00000X
WV752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720549OtherBLUE CROSS BLUE SHIELD #
WV1068911OtherWORKER'S COMPENSATION #
WV3810006848Medicaid
WV9480068000Medicaid
WV3810006848Medicaid