Provider Information for 1679840227
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Dr. JONATHAN B WILSON PhD, LMFT-S
Sex: Male
NPI: 1679840227
Last Updated: 2024-08-05
Certification Date: 2024-08-05
Certification Date: 2024-08-05
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1679840227 | ||||||||||||
| Enumeration Date | 2011-11-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5130 GOODWIN AVE DALLAS, TX 75206-6205 United States Phone: 972-638-7485 | Fax: | ||||||||||||
| Primary Practice Address | 5130 GOODWIN AVE DALLAS, TX 75206-6205 United States Phone: 972-638-7485 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 5109 MISSION AVE 3630 N SHILOH RD STE 202 4500 MERCANTILE PLAZA DR STE 204 | ||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|