Provider Demographics
NPI:1588483879
Name:WILSON, EVREN NYX (LSW)
Entity type:Individual
Prefix:
First Name:EVREN
Middle Name:NYX
Last Name:WILSON
Suffix:
Gender:X
Credentials:LSW
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:ABIGAIL
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 N ALABAMA ST APT 1612
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1358
Mailing Address - Country:US
Mailing Address - Phone:812-709-9014
Mailing Address - Fax:
Practice Address - Street 1:700 N ALABAMA ST APT 1612
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1358
Practice Address - Country:US
Practice Address - Phone:812-709-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012545A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker