| Doctor Name: | MR. TONY WILSON |
| NPI Number: | 1255603635 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED,LPC |
| License Number: | OK-4702 |
| Business Practice Address: | 14844 E County Road 1520 Lindsay, OK - 730529299 |
| Business Phone Number: | 4057566082 |
| Business Fax Number: | 4053104052 |
| Mailing Address: | Po Box 306, LINDSAY |
| State: | OK |
| Postal Code: | 730520306 |
| Phone Number: | 4057566082 |
| Fax Number: | 4053104052 |
| NPI Enumeration Date: | 02/01/2012 |
| NPI Last Update Date: | 06/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | OK-4702 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |