Individual
JUSTIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MENTAL HEALTH TECH
Contact information
Practice address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 424-7711
Mailing address
9211 N COUNCIL RD APT 140, OKLAHOMA CITY, OK 73132-1338
(405) 429-9948
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/14/2016
Last updated
05/14/2016
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