Individual
ELEANOR WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC., LMSW
Contact information
Practice address
6331 W 110TH ST, OVERLAND PARK, KS 66211
(913) 696-1911
Mailing address
1663 W 110TH ST, OVERLAND PARK, KS 66211
(913) 696-1911
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1030
KS
104100000X
Social Worker
9822
KS
Other
Enumeration date
11/09/2016
Last updated
11/10/2016
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