Individual
KEVIN POUL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1819 N DOVER ST, INDEPENDENCE, MO 64058-1231
(816) 796-9875
Mailing address
1819 N DOVER ST, INDEPENDENCE, MO 64058-1231
(816) 796-9875
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2009033311
MO
Other
Enumeration date
12/15/2009
Last updated
11/05/2014
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