Active NPI
Tequilla Jane Wilson, PH. D
- Clinical Psychologist
- Houston, TX
National Provider Identifier
1417221888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 32060
- Practice address
- 726 Redwing Place Dr
Houston, TX 77009-2472 - Phone
- (713) 868-9537
- NPI assigned
- Mar 2, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 32060 | TX | Primary |
Addresses
Primary practice location
726 Redwing Place Dr
Houston, TX 77009-2472
Mailing address
726 Redwing Place Dr
Houston, TX 77009-2472
Phone (713) 868-9537
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32060 | TX | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1417221888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "726 REDWING PLACE DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770092472",
"telephone_number": "713-868-9537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "726 REDWING PLACE DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770092472",
"telephone_number": "713-868-9537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TEQUILLA",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "PH. D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-02",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "32060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.