Juan Wilson, LCSW, LCAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

87001672A Issued in IN

Practice address

9623 Windermere Blvd
Fishers, IN 46037-9180

Phone

(888) 416-4646

NPI assigned

Nov 14, 2022

Sex

Male

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

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1356059844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DIAMOND LN",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479338320",
            "telephone_number": "765-918-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9623 WINDERMERE BLVD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379180",
            "telephone_number": "888-416-4646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Diamond Ln",
            "address_purpose": "LOCATION",
            "city": "Crawfordsville",
            "state": "IN",
            "postal_code": "479338320",
            "country_code": "US",
            "telephone_number": "765-918-3923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JUAN",
        "credential": "LCSW, LCAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-14",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34010348A",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001672A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shonda Williams
• Lisa Willis, MSSW, LSW
• Megan Willmann, M.A., CCC-SLP
• Denice Willoughby
• Amanda Marie Wilson, RDN
• Markayla Wilson
• Riana Wilson
• Steven Wilson
• Wise Chiropractic Center PC
• Shannon J Wise, D.C.

• Addiction (Substance Use Disorder) Counselor in Fishers, IN
• Providers in Fishers, IN by specialty
• Addiction (Substance Use Disorder) Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.

Verify at the official NPI Registry.