Individual
MR. TYROLIA DEJUAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1121 N 5TH ST, KANSAS CITY, KS 66101-2305
(913) 831-2820
(913) 831-0262
Mailing address
509 E ELM ST, SALINA, KS 67401-2353
(785) 825-0541
(785) 825-0062
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
949
KS
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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