Organization
WILSON PSYCHOLOGICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH SPENCER WILSON PHD (PSYCHOLOGIST)
(918) 337-6050
Entity
Organization
Contact information
Practice address
501 S JOHNSTONE AVE, SUITE 503, BARTLESVILLE, OK 74003-6622
(918) 337-6050
(918) 337-6061
Mailing address
501 S JOHNSTONE AVE, SUITE 503, BARTLESVILLE, OK 74003-6622
(918) 337-6050
(918) 337-6061
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
966
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200029610A
—
OK
01
—
200522095
MEDICARE NUMBER
OK
Enumeration date
09/15/2006
Last updated
09/21/2023
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