Provider Demographics
NPI:1285809392
Name:WILSON, RONALD TERRY (PSYD, LCAC, LMFT)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:TERRY
Last Name:WILSON
Suffix:
Gender:M
Credentials:PSYD, LCAC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3131
Mailing Address - Country:US
Mailing Address - Phone:270-454-4558
Mailing Address - Fax:
Practice Address - Street 1:104 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3131
Practice Address - Country:US
Practice Address - Phone:270-454-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001951A101Y00000X, 101YA0400X, 101YM0800X
IN87000390A101YA0400X
KY168501101YA0400X
IN3900195AA101YM0800X
964686101YS0200X
IN35001731A106H00000X
CA31505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist