Provider Demographics
NPI:1457022402
Name:WILSON, REBECCA (LMHC, LPC-S)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC, LPC-S
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, LPC-S
Mailing Address - Street 1:631 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:631 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2115
Practice Address - Country:US
Practice Address - Phone:210-538-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZ17084101YP2500X
WALH61549156101YP2500X
TX91137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health