| Doctor Name: | HOLLY K WILSON |
| NPI Number: | 1245557958 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0119501 |
| Business Practice Address: | 107 Sunset Loop Mescalero, NM - 88340 |
| Business Phone Number: | 5754644338 |
| Business Fax Number: | 5754644331 |
| Mailing Address: | Po Box 228, MESCALERO |
| State: | NM |
| Postal Code: | 883400228 |
| Phone Number: | 5754644338 |
| Fax Number: | 5754644331 |
| NPI Enumeration Date: | 04/21/2010 |
| NPI Last Update Date: | 04/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0119501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |