Tammy Sue Wilson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401017239 Issued in MI

Practice address

3115 Lapeer Rd Ste a
Port Huron, MI 48060-7309

Phone

(810) 637-1183

Fax

(810) 637-1183

NPI assigned

Jan 26, 2017

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Tammy Sue Wilson

  • Professional Counselor
  • Port Huron, MI
  • NPI 1174255830

  Mental Health

  NPD Authorized official
• Colonial Woods Missionary Church

  • Clinic/Center
  • Port Huron, MI
  • NPI 1033372818

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1265979355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3115 LAPEER RD STE A",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480607309",
            "telephone_number": "810-637-1183",
            "fax_number": "810-637-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 LAPEER RD STE A",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480607309",
            "telephone_number": "810-637-1183",
            "fax_number": "810-637-1183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "626 Busha Hwy",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "MI",
            "postal_code": "480401310",
            "country_code": "US",
            "telephone_number": "810-637-1183",
            "fax_number": "810-637-1183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TAMMY",
        "middle_name": "SUE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-26",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401017239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willow Enterprises
• Jessica Elaine Wills
• Heather Wilson-Vani, RN FNP-C
• Ashley Lauren Wilson, PA-C
• Jenne Wilson
• Joseph Windhorst, LMSW
• Debra Lynn Wine, MSW
• Rachel Nicole Winters Graham
• Samantha Winward-Maes
• Aleesha Pearl Wise, FNP-C

• All providers in Port Huron, MI
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.