Provider Demographics
NPI:1063699973
Name:WILSON, MARIE A (T-LMFT)
Entity type:Individual
Prefix:PROF
First Name:MARIE
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:PROF
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:T-LMFT
Mailing Address - Street 1:119 JONES ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-1469
Mailing Address - Country:US
Mailing Address - Phone:316-322-9600
Mailing Address - Fax:
Practice Address - Street 1:119 JONES ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-1469
Practice Address - Country:US
Practice Address - Phone:316-322-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist