Individual
MR. MICHAEL PAUL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED.
Contact information
Practice address
1309 S 13TH ST, CHICKASHA, OK 73018-4248
(405) 638-0312
Mailing address
1309 S 13TH ST, CHICKASHA, OK 73018-4248
(405) 638-0312
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4678
OK
103TS0200X
School Psychologist
0542036
OK
Other
Enumeration date
05/10/2011
Last updated
02/14/2013
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