Provider Demographics
NPI:1548373244
Name:WILSON, LUCY ERMA (PHD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:ERMA
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E RIVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5744
Mailing Address - Country:US
Mailing Address - Phone:520-326-5525
Mailing Address - Fax:520-696-0423
Practice Address - Street 1:1050 E RIVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5744
Practice Address - Country:US
Practice Address - Phone:520-326-5525
Practice Address - Fax:520-696-0423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPHD1292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical