Individual
CHARLES JAY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
711 N MARKET AVE, BOLIVAR, MO 65613-1114
(417) 399-1793
Mailing address
711 N MARKET AVE, BOLIVAR, MO 65613-1114
(417) 399-1793
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2016008451
MO
Other
Enumeration date
03/29/2016
Last updated
05/05/2026
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