Jenise Delores Wilson, MS, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

786-6-1-14-293 Issued in ND

Practice address

1110 College Dr Ste 206
Bismarck, ND 58501-1207

Phone

(701) 258-2008

NPI assigned

Jul 10, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trauma and Attachment Institute LLCGroup PAC ID 8426584020, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Trauma and Attachment Institute LLC

  • Mental Health Counselor
  • Bismarck, ND
  • NPI 1710704929
  Medicare reassignment Care Compare group NPD Authorized official
• University of North Dakota

  • Family Medicine Physician
  • Bismarck, ND
  • NPI 1619905528
  Medicare reassignment NPD
• Soul Survivor Counseling Services PC

  • Mental Health Counselor
  • Bismarck, ND
  • NPI 1831502152
  NPD
• University of North Dakota

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1952969099
  NPD
• Bismarck Psychological Associates, PLLC

  • Psychologist
  • Bismarck, ND
  • NPI 1144670019
  NPD (past)

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1063934230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N 27TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585013115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 COLLEGE DR STE 206",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585011207",
            "telephone_number": "701-258-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JENISE",
        "middle_name": "DELORES",
        "credential": "MS, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-10",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ND",
            "license": "786-6-1-14",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ND",
            "license": "786-6-1-14-293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1472904",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krista Williams, LPN
• Margaret Williams, FNP
• Karin Willis, M.D.
• Desiree N. Willman, DPT
• Henry Kobina Wilson
• Jonathan O. Wilson
• Kimberly Wilson, PHARM D
• Kiyanna G Wilson
• Nichole Carol Wilson, RN
• Timothy Wilson

• Professional Counselor in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Professional Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.