Shane Ray Wilson, LPC,LADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2179 Issued in OK

Practice address

3750 W Main St Ste Aa
Norman, OK 73072-4645

Phone

(405) 474-9374

NPI assigned

Jan 12, 2010

Last updated

Dec 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Oklahoma Mental Health Consulting LLC

  • Community/Behavioral Health Agency
  • Norman, OK
  • NPI 1821436064
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1063742138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 W MAIN ST STE AA",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730724645",
            "telephone_number": "405-474-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 W MAIN ST STE AA",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730724645",
            "telephone_number": "405-474-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHANE",
        "middle_name": "RAY",
        "credential": "LPC,LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-12",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "135",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "2179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Alan Wilson, MD
• Pamela L Wilson, DO
• Patrick S Wilson
• Rebecca Wilson
• Ryan D Wilson, DO
• Sharita Renee Wilson
• Stephanie L Wilson, MS, LBP
• Stephanie Lee Wilson, DPT
• Tonya Gayle Wilson, LPN
• Tyara Elizabeth Ann Wilson

• Professional Counselor in Norman, OK
• Providers in Norman, OK by specialty
• Professional Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.