LARRY DWIGHT WILSON JR.


Address: 3020 18th St Suite 17, Catholic Charities, Columbus, NE 68601-4254
Phone: 4025633833

LARRY DWIGHT WILSON JR. (NPI# 1538344908) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1538344908
Entity Type Individual
Full Name LARRY DWIGHT WILSON JR.
Credential LMHP, LADC, CPC
Practice Address 3020 18th St Suite 17
Catholic Charities
Columbus
NE 68601-4254
Mailing Address 3300 N 60th St
Catholic Charities
Omaha
NE 68104-3402
Practice Telephone 4025633833
Practice Fax Number 4025628714
Mailing Telephone 4025540520
Mailing Fax Number 4025518797
Enumeration Date 2008-01-04
Last Update Date 2012-05-09
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
819 NE Behavioral Health & Social Service Providers
N 101YM0800X Counselor
Specialization: Mental Health
3523 NE Behavioral Health & Social Service Providers
N 101YP2500X Counselor
Specialization: Professional
1770 NE Behavioral Health & Social Service Providers

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Office Location

Street Address 3020 18TH ST SUITE 17
CATHOLIC CHARITIES
City COLUMBUS
State NE
Zip Code 68601-4254

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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

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Competitor

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City COLUMBUS
Zip Code 68601

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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