Provider Demographics
NPI:1396241162
Name:WILSON, KAYCEE (LMHC)
Entity type:Individual
Prefix:
First Name:KAYCEE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 N COLLEGE AVE STE LL8
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3188
Mailing Address - Country:US
Mailing Address - Phone:463-266-9774
Mailing Address - Fax:317-600-3177
Practice Address - Street 1:5420 N COLLEGE AVE STE LL8
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3188
Practice Address - Country:US
Practice Address - Phone:463-266-9774
Practice Address - Fax:317-600-3177
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003225A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health