Individual
ELIZABETH ANN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6221 W GORE BLVD, LAWTON, OK 73505-5836
(580) 351-9998
Mailing address
6221 W GORE BLVD, LAWTON, OK 73505-5836
(580) 713-1126
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
317531
OK
Other
Enumeration date
01/18/2023
Last updated
02/27/2025
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