Provider Demographics
NPI:1962118323
Name:WILSON, KATHERINE MCMILLAN (LPC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MCMILLAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14823 SOPRAS CIR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4412
Mailing Address - Country:US
Mailing Address - Phone:214-794-5877
Mailing Address - Fax:
Practice Address - Street 1:14823 SOPRAS CIR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4412
Practice Address - Country:US
Practice Address - Phone:214-794-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8275101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8275OtherLICENSED PROFESSIONAL COUNSELOR