Individual
BRIAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2920 KNIGHT ST STE 155, SHREVEPORT, LA 71105-2412
(318) 272-6667
Mailing address
2920 KNIGHT ST STE 155, SHREVEPORT, LA 71105-2412
(318) 272-6667
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PLC10301
LA
Other
Enumeration date
05/22/2024
Last updated
10/08/2025
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