Active NPI
Ronald Terry Wilson, PSYD, LCAC, LMFT
- Clinical Psychologist
- Henderson, KY
National Provider Identifier
1285809392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 31505
- Practice address
- 104 N Elm St
Henderson, KY 42420-3131 - Phone
- (270) 454-4558
- NPI assigned
- Apr 29, 2008
- 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 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 39001951A | IN | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 87000390A | IN | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 168501 | KY | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 39001951A | IN | |
| Mental Health Counselor | 101YM0800X | 3900195AA | IN | |
| Mental Health Counselor | 101YM0800X | 39001951A | IN | |
| School Counselor | 101YS0200X | 964686 | ||
| Marriage & Family Therapist | 106H00000X | 35001731A | IN | |
| Clinical Psychologist | 103TC0700X | 31505 | CA | Primary |
Addresses
Primary practice location
104 N Elm St
Henderson, KY 42420-3131
Mailing address
104 N Elm St
Henderson, KY 42420-3131
Phone (270) 454-4558
Other practice location 1
125 N Weinbach Ave Ste 410
Evansville, IN 47711-6091
Phone (812) 421-9900
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 |
|---|---|---|---|
| 39001951A | IN | MD | Counselor |
| 87000390A | IN | MD | Addiction (Substance Use Disorder) Counselor |
| 168501 | KY | MD | Addiction (Substance Use Disorder) Counselor |
| 3900195AA | IN | MD | Mental Health Counselor |
| 31505 | CA | MD | Clinical Psychologist |
| 35001731A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678752000000",
"number": "1285809392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 N ELM ST",
"city": "HENDERSON",
"state": "KY",
"postal_code": "424203131",
"telephone_number": "270-454-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 N ELM ST",
"city": "HENDERSON",
"state": "KY",
"postal_code": "424203131",
"telephone_number": "270-454-4558"
}
],
"practiceLocations": [
{
"address_1": "125 N Weinbach Ave Ste 410",
"address_purpose": "LOCATION",
"city": "Evansville",
"state": "IN",
"postal_code": "477116091",
"country_code": "US",
"telephone_number": "812-421-9900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "RONALD",
"middle_name": "TERRY",
"name_prefix": "Dr.",
"credential": "PSYD, LCAC, LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2023-03-14",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IN",
"license": "39001951A",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "87000390A",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "KY",
"license": "168501",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "39001951A",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "3900195AA",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39001951A",
"primary": false
},
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": null,
"license": "964686",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35001731A",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "31505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.