Individual
SHANE RAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC,LADC
Contact information
Practice address
3750 W MAIN ST STE AA, NORMAN, OK 73072-4645
(405) 474-9374
Mailing address
3750 W MAIN ST STE AA, NORMAN, OK 73072-4645
(405) 474-9374
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
135
OK
101YP2500X
Professional Counselor
Primary
2179
OK
Other
Enumeration date
01/12/2010
Last updated
12/21/2023
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