Individual
MR. JOEL SHANE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPCC
Contact information
Practice address
155 LEES VALLEY RD, SHEPHERDSVILLE, KY 40165-6143
(502) 472-9833
(502) 805-0600
Mailing address
10011 SEATONVILLE RD, LOUISVILLE, KY 40291-3541
(502) 472-9833
(502) 805-0600
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0550
KY
101YP2500X
Professional Counselor
Primary
103656
KY
101YP2500X
Professional Counselor
18552
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0550
LICENSE PROFESSIONAL CLINICAL COUNSELOR
KY
01
—
103656
UPDATED KY LICENSE PROFESSIONAL COUNSELOR NUMBER
KY
01
—
11662641
CAQH PROVIDER ID
—
05
—
162300103
—
TX
01
—
18552
LICENSE PROFESSIONAL COUNSELOR
TX
01
—
61254
NATIONAL CERTIFIED COUNSELOR
—
05
—
7100267760
—
KY
Enumeration date
08/30/2006
Last updated
03/01/2022
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