Active NPI
Connie J. Wilson, PSY.D.
- Clinical Psychologist
- Visalia, CA
National Provider Identifier
1194925420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 18473
- Practice address
- 720 W Center Ave Ste C
Visalia, CA 93291-6047 - Phone
- (559) 733-4566
- Fax
- (559) 733-4566
- NPI assigned
- Jul 24, 2007
- Last updated
- Apr 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 18473 | CA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY 18473 | CA |
Addresses
Primary practice location
720 W Center Ave Ste C
Visalia, CA 93291-6047
Mailing address
720 W Center Ave Ste C
Visalia, CA 93291-6047
Phone (559) 733-4566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 25, 2023 through Jul 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 18473 | CA | MD | Clinical Child & Adolescent Psychologist |
| 18473 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272499200000",
"number": "1194925420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 W CENTER AVE STE C",
"city": "VISALIA",
"state": "CA",
"postal_code": "932916047",
"telephone_number": "559-733-4566",
"fax_number": "559-733-4566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 W CENTER AVE STE C",
"city": "VISALIA",
"state": "CA",
"postal_code": "932916047",
"telephone_number": "559-733-4566",
"fax_number": "559-733-4566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CONNIE",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-24",
"last_updated": "2010-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 18473",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY 18473",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Visalia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.