| Doctor Name: | KELLI WILSON |
| NPI Number: | 1215069356 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MBS |
| License Number: | 2732 |
| Business Practice Address: | 221 Ridgecrest Dr Calera, OK - 747302510 |
| Business Phone Number: | 5809246363 |
| Business Fax Number: | 5809240379 |
| Mailing Address: | 221 Ridgecrest Dr, CALERA |
| State: | OK |
| Postal Code: | 747302510 |
| Phone Number: | 5809246363 |
| Fax Number: | 5809240379 |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2732 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |