Individual
MR. KEVIN JEROME WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
970 E. 126TH TERRACE, OLATHE, KS 66061
(913) 548-2481
Mailing address
970 E. 126TH TERRACE, OLATHE, KS 66061
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
K02-48-0063
KS
Other
Enumeration date
03/14/2013
Last updated
03/14/2013
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