Provider Demographics
NPI:1972776946
Name:WILSON, PAULA LORENE (LCMFT)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LORENE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 PARKHILL ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1426
Mailing Address - Country:US
Mailing Address - Phone:913-634-1987
Mailing Address - Fax:
Practice Address - Street 1:4937 PARKHILL ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1426
Practice Address - Country:US
Practice Address - Phone:913-634-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist