Latisha Denise Wilson, LPC, LMFT-A, LCDC-I

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

79124 Issued in TX

Practice address

507 N 8TH St
Killeen, TX 76541-4867

Phone

(254) 523-6710

NPI assigned

Jun 28, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1447745716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 E STAN SCHLUETER LOOP # 68",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765424813",
            "telephone_number": "254-523-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 N 8TH ST",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765414867",
            "telephone_number": "254-523-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LATISHA",
        "middle_name": "DENISE",
        "credential": "LPC, LMFT-A, LCDC-I",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "33788",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "79124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403747501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Geri Lynne Wilson
• Jason Paul Wilson, LMFT
• Kelli Jayne Wilson, P.T.
• Kimberly Frances Wilson, CD-L,PIC
• Kristi Wilson
• Mark D. Wilson, MD
• Natasha Nicole Wilson, LPC-A, LCDC-I
• Rylee Wilson
• Destiny Winkfield
• Denasia Tashae Winston

• Mental Health Counselor in Killeen, TX
• Providers in Killeen, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.