Provider Demographics
NPI:1548637564
Name:WILSON, SHELBY (LCSW)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66558
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6558
Mailing Address - Country:US
Mailing Address - Phone:225-922-2700
Mailing Address - Fax:225-362-5319
Practice Address - Street 1:422 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6505
Practice Address - Country:US
Practice Address - Phone:225-922-0478
Practice Address - Fax:225-922-2658
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133731041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool