Provider Demographics
NPI:1730853458
Name:WILSON, NATOSHA NICHOLE (LMFT-S, LCDC)
Entity type:Individual
Prefix:
First Name:NATOSHA
Middle Name:NICHOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19915 RANSTEN LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5288
Mailing Address - Country:US
Mailing Address - Phone:832-469-4955
Mailing Address - Fax:
Practice Address - Street 1:3845 CYPRESS CREEK PKWY STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3519
Practice Address - Country:US
Practice Address - Phone:832-469-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15729101YA0400X
TX203175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)