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Individual

KIM WILGUS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A., L.P.C.

Contact information

Practice address
517 W BOZKA ST, SHINER, TX 77984-5598
(361) 935-6240
Mailing address
517 WEST BOZKA, SHINER, TX 77984-1464
(361) 935-6240
(833) 340-7343

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
19500
TX
101YP2500X
Professional Counselor
19500
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
011735136
TX
01
202876529
TAX ID
TX
Enumeration date
08/08/2006
Last updated
06/13/2024
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