Individual
AMY NICOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., M.S.
Contact information
Practice address
117 S 7TH ST, CHICKASHA, OK 73018-3301
(405) 222-4786
Mailing address
508 W HIGHWAY 277, NINNEKAH, OK 73067-3804
(405) 278-1694
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11968
OK
101YM0800X
Mental Health Counselor
Primary
LPCCANDIDATE11968
OK
171M00000X
Case Manager/Care Coordinator
318398
OK
Other
Enumeration date
08/28/2023
Last updated
04/27/2026
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