Organization
DENNIS W WILSON PHD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS W WILSON PHD (OWNER)
(731) 431-0609
Entity
Organization
Contact information
Practice address
1020 ELLINGTON DR, MILAN, TN 38358-3150
(731) 431-0609
Mailing address
728 BLACKMON STREET, MEDINA, TN 38355-6829
(731) 431-0609
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36815542
—
TN
Enumeration date
08/15/2007
Last updated
06/09/2011
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