Active NPI
Earl Wilson III, REV, LMFT
- Marriage & Family Therapist
- Jackson, MS
National Provider Identifier
1164630018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35001450
- Practice address
- 6205 Hanging Moss Rd
Jackson, MS 39206-2121 - Phone
- (601) 982-3997
- Fax
- (601) 982-8933
- NPI assigned
- May 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 35001450 | IN | Primary |
Addresses
Primary practice location
6205 Hanging Moss Rd
Jackson, MS 39206-2121
Mailing address
706 Colonial Cir
Jackson, MS 39211-3208
Phone (601) 899-5827
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35001450 | IN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Matters Counseling Center | Marriage & Family Therapist | Past | Accepting new patients |
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.
-
- Professional Counselor
- Fort Worth, TX
- NPI 1922646868
Marriage & Family Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164630018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 COLONIAL CIR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392113208",
"telephone_number": "601-899-5827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6205 HANGING MOSS RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392062121",
"telephone_number": "601-982-3997",
"fax_number": "601-982-8933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EARL",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "REV, LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35001450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.