Provider Information for 1376040071
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JUDY NELL WILSON MA, LPC
Sex: Female
NPI: 1376040071
Last Updated: 2018-04-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1376040071 | ||||||||
| Enumeration Date | 2018-04-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4900 WINDHAVEN PKWY APT 15102 LEWISVILLE, TX 75056-6110 United States Phone: 972-754-0313 | Fax: | ||||||||
| Primary Practice Address | 12959 JUPITER RD STE 254 DALLAS, TX 75238-5250 United States Phone: 214-221-0132 | Fax:214-221-0242 | ||||||||
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