Active NPI
Dawn Marcelle Wilson, LCSW
- Clinical Social Worker
- Tyler, TX
National Provider Identifier
1437757077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 69032
- Practice address
- 1358 E Richards St
Tyler, TX 75702-6153 - Phone
- (903) 595-5525
- Fax
- (903) 531-9328
- NPI assigned
- Oct 15, 2020
- Sex
- Female
- Sole proprietor
- No
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 Social Worker | 1041C0700X | 69032 | TX | Primary |
Addresses
Primary practice location
1358 E Richards St
Tyler, TX 75702-6153
Mailing address
PO Box 1238
Tyler, TX 75710-1238
Phone (903) 595-5525
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 |
|---|---|---|---|
| 69032 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602720000000",
"number": "1437757077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1238",
"city": "TYLER",
"state": "TX",
"postal_code": "757101238",
"telephone_number": "903-595-5525",
"fax_number": "903-531-9328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1358 E RICHARDS ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757026153",
"telephone_number": "903-595-5525",
"fax_number": "903-531-9328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DAWN",
"middle_name": "MARCELLE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-15",
"last_updated": "2020-10-15",
"certification_date": "2020-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "69032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.