Provider Demographics
NPI:1972926673
Name:WILSON, JANA (BS MHP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:BS MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-0701
Mailing Address - Country:US
Mailing Address - Phone:270-816-2671
Mailing Address - Fax:
Practice Address - Street 1:560 OAKLAND CIR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8924
Practice Address - Country:US
Practice Address - Phone:127-081-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168587101YM0800X
KY272387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY168587OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE