Individual
LOUIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8300 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110-7613
(505) 291-2134
(505) 291-2967
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1319
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000A3425
—
NM
Enumeration date
11/10/2005
Last updated
05/02/2019
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