Individual
MRS. JESSICA A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA/LADC-MH
Contact information
Practice address
3000 UNITED FOUNDERS BLVD STE 239, OKLAHOMA CITY, OK 73112-4294
(405) 265-9047
(405) 265-9049
Mailing address
12444 NW 10TH ST STE 202, #157, YUKON, OK 73099-5845
(405) 265-9047
(405) 265-9049
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1321
OK
101YM0800X
Mental Health Counselor
1321
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1321
LADC LICENSE
OK
Enumeration date
03/08/2012
Last updated
08/16/2022
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