Jeff Randall Wilson

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

141 W 46TH Ave
Gary, IN 46408-3905

Phone

(219) 614-0793

NPI assigned

Mar 16, 2009

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Word of Truth Christian Church U.S.a., Inc.

  • Community/Behavioral Health Agency
  • Gary, IN
  • NPI 1508099821
  NPD (past) Authorized official
• Word of Truth Christian Church U.S.a., Inc.

  • Case Management Agency
  • Gary, IN
  • NPI 1043543895
  NPD (past)

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237161600000",
    "number": "1598906935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W 46TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464083905",
            "telephone_number": "219-614-0793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W 46TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464083905",
            "telephone_number": "219-614-0793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFF",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willowglen Academy - Indiana
• Willowglen Academy - Indiana
• Willowglen Academy-in, Inc
• Willowglen Academy-in, Inc.
• Cheryl Denise Wilson
• Ruth Bernice Wilson, MS
• Lonnie Winborn
• Cornelia Winder
• Nathan Winsor
• Debra Winters, RN

• Counselor in Gary, IN
• Providers in Gary, IN by specialty
• Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; 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.