Cassandra Wilson, LPC-I

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

78966 Issued in TX

Practice address

6100 Western PL Ste 908
Fort Worth, TX 76107-4600

Phone

(817) 751-7802

Fax

(847) 859-5885

NPI assigned

Nov 12, 2019

Last updated

Nov 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• PHC of Buffalo Grove Clinical Psychology

  dba Portrait Health Centers

  • Psychologist
  • Vernon Hills, IL
  • NPI 1235430612
  NPD

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1811532062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY STE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611454",
            "telephone_number": "847-737-8768",
            "fax_number": "847-859-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 WESTERN PL STE 908",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761074600",
            "telephone_number": "817-751-7802",
            "fax_number": "847-859-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CASSANDRA",
        "credential": "LPC-I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-12",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "78966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilson J. Garcia, M.D. , P.a.
• Anna Wilson, RBT
• Anna Wilson
• Benjamin Wilson, D.O.
• Beth R Wilson, S.L.P
• Courtney Wilson, LPC
• Courtney Laine Wilson, LCSW
• Courtney Lynn Wilson, NNP
• Cynthia Blair Wilson, PT, DPT
• Daphne Elizabeth Wilson, MSSW

• Mental Health Counselor in Fort Worth, TX
• Providers in Fort Worth, 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 Nov 12, 2019; 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.