Individual
KIMBERLY WISLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSCP, LPC, LSOTP
Contact information
Practice address
10221 DESERT SANDS ST, SUITE 211, SAN ANTONIO, TX 78216-3959
(210) 834-7762
(210) 349-2273
Mailing address
10221 DESERT SANDS ST, SUITE 211, SAN ANTONIO, TX 78216-3959
(210) 834-7762
(210) 349-2273
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
17628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6199LC
BCBS
—
Enumeration date
12/17/2007
Last updated
12/17/2007
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