Louis Wilson
Counselor, Professional in Albuquerque, NM. Individual provider (NPI-1).
NPI number1144201633
StatusActive
Last updated in NPPESMay 2, 2019
Details
- NPI
- 1144201633
- Entity type
- Individual (NPI-1)
- Name
- Louis Wilson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 10, 2005
- Last updated
- May 2, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 1319 | NM | Yes |
Practice location
8300 Constitution Ave NeAlbuquerque, NM 87110-7613
Phone 505-291-2134 · Fax 505-291-2967
Mailing address
Po Box 26666Phs Provider Enrollment
Albuquerque, NM 87125-6666
Phone 505-923-6770 · Fax 505-923-5354
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