Provider Demographics
NPI:1598585077
Name:WILSON, JASALEE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JASALEE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW AVENUE E
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:TX
Mailing Address - Zip Code:79520-3814
Mailing Address - Country:US
Mailing Address - Phone:325-439-9556
Mailing Address - Fax:
Practice Address - Street 1:5189 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4529
Practice Address - Country:US
Practice Address - Phone:325-232-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95840101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional