Doctor Name: | MR. NATHAN RAY WILSON |
NPI Number: | 1306959077 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | C.M.A. |
License Number: | |
Business Practice Address: | 804 W Choctaw Ave Chickasha, OK - 730182310 |
Business Phone Number: | 4052220622 |
Business Fax Number: | |
Mailing Address: | 4825 Bismarc Dr, DEL CITY |
State: | OK |
Postal Code: | 731154413 |
Phone Number: | 4052088753 |
Fax Number: | |
NPI Enumeration Date: | 08/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |