Individual
MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3027 PLEASANT GRV, BOSSIER CITY, LA 71111-5758
(318) 208-4420
Mailing address
3027 PLEASANT GRV, BOSSIER CITY, LA 71111-5758
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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