Provider Demographics
NPI:1497104103
Name:ANN WILSON, PSY.D. PC
Entity type:Organization
Organization Name:ANN WILSON, PSY.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:832-919-5732
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:AZ
Mailing Address - Zip Code:86331-0173
Mailing Address - Country:US
Mailing Address - Phone:832-919-5732
Mailing Address - Fax:832-583-0012
Practice Address - Street 1:2901 WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3399
Practice Address - Country:US
Practice Address - Phone:713-300-0713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty