Active NPI
Jerry Clyde Wilson, M.S., L.P.C.
- Mental Health Counselor
- Nacogdoches, TX
National Provider Identifier
1750437158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 625
- Practice address
- 3516 NE Stallings Dr
Nacogdoches, TX 75965-8732 - Phone
- (936) 569-6562
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 625 | TX | Primary |
Addresses
Primary practice location
3516 NE Stallings Dr
Nacogdoches, TX 75965-8732
Mailing address
PO Box 630325
Nacogdoches, TX 75963-0325
Phone (936) 569-6562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 17, 2025 through Nov 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 625 | TX | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750437158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 630325",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759630325",
"telephone_number": "936-569-6562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3516 NE STALLINGS DR",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759658732",
"telephone_number": "936-569-6562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JERRY",
"middle_name": "CLYDE",
"name_prefix": "Mr.",
"credential": "M.S., L.P.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
- Ciara Williams, FNP-C
- Joseph Donald Williams, PHARM.D.
- Leslie Ann Williams, NP
- Timothy Roger Williamson
- Cheryl Busbice Wilson, L.C.S.W.
- Joni M Wilson
- Melanie Lynn Wilson, RN, CNM
- Winnie-Stowell Hospital District (Stallings Court Nursing and Rehabilitation)
- Winnie-Stowell Hospital District (Willowbrook Nursing Center)
- Reyna Nicole Witherspoon, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.