Individual provider Active NPI

Vosia Xan Wilson, LPC

  • Counselor
  • Tulsa, OK
National Provider Identifier
1053659946
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
7167 Issued in OK
Practice address
3606 N Martin Luther King Jr Blvd
Tulsa, OK 74106-6447
Phone
(918) 949-4212
Fax
(918) 949-4299
NPI assigned
Jan 28, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Blind Rehabilitation Specialist/Technologist 2255R0406X
Counselor 101Y00000X 7167 OK Primary

Addresses

Primary practice location

3606 N Martin Luther King Jr Blvd
Tulsa, OK 74106-6447

Mailing address

512 E 40TH St N
Tulsa, OK 74106-1512
Phone (918) 804-8618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240112001611 OK Practitioner - Mental Health Counselor 8921459041 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7167OKMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Sydlyfe Counseling Services, LLC CurrentSince Jan 1, 2024 Accepting new patients

Locations

3606 N Martin Luther King Jr Blvd
Tulsa, OK 74106
Phone (918) 728-8512

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1053659946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 E 40TH ST N",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741061512",
            "telephone_number": "918-804-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 N MARTIN LUTHER KING JR BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741066447",
            "telephone_number": "918-949-4212",
            "fax_number": "918-949-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "VOSIA",
        "middle_name": "XAN",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-28",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255R0406X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Rehabilitation, Blind",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OK",
            "license": "7167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.