Active NPI
Deborah Chelette - Wilson, LPC
- Professional Counselor
- Longview, TX
National Provider Identifier
1730173253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 15127
- Practice address
- 108 Wain Dr Ste B
Longview, TX 75604-1231 - Phone
- (903) 850-6334
- Fax
- (906) 236-8510
- NPI assigned
- Sep 12, 2005
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 15127 | TX | Primary |
Addresses
Primary practice location
108 Wain Dr Ste B
Longview, TX 75604-1231
Mailing address
1804 Livingston St
Longview, TX 75601-3724
Phone (903) 850-6334
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 028036401 | Medicaid | TX | |
| 15127 | Other | TX | LICENSE NUMBER |
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 |
|---|---|---|---|
| 15127 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Country Pathways PLLC | Professional | Current | Accepting new patients |
| Teladoc Health Medical Group, P.a. | Professional | Current | Accepting new patients |
Locations
108 Wain Dr
Ste B
Longview, TX 75604
Phone (903) 850-6334
Interoperability endpoints
- deborahchelettewilson@tdh.allscriptsdirect.net
Organizations & group practices 2
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.
-
- Professional Counselor
- Longview, TX
- NPI 1902079437
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585612800000",
"number": "1730173253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 LIVINGSTON ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756013724",
"telephone_number": "903-850-6334",
"fax_number": "903-365-2198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 WAIN DR STE B",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756041231",
"telephone_number": "903-850-6334",
"fax_number": "906-236-8510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHELETTE - WILSON",
"first_name": "DEBORAH",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-12",
"last_updated": "2020-03-31",
"certification_date": "2020-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "15127",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "028036401",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "15127",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.