Active NPI
Albert Graham Wilson IV, LPC
- Professional Counselor
- Saint Paul, MN
National Provider Identifier
1376604108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 01026
- Practice address
- 370 Selby Ave
#316 Union Therapy
Saint Paul, MN 55102-1852 - Phone
- (612) 305-8081
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 01026 | MN | Primary |
Addresses
Primary practice location
370 Selby Ave
#316 Union Therapy
Saint Paul, MN 55102-1852
Mailing address
370 Selby Ave
#316 Union Therapy
Saint Paul, MN 55102-1852
Phone (612) 305-8081
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 |
|---|---|---|---|
| 01026 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1376604108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "370 SELBY AVE",
"address_2": "#316 UNION THERAPY",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551021852",
"telephone_number": "612-305-8081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "370 SELBY AVE",
"address_2": "#316 UNION THERAPY",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551021852",
"telephone_number": "612-305-8081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ALBERT",
"middle_name": "GRAHAM",
"name_prefix": "Mr.",
"name_suffix": "IV",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "01026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.