Active NPI
Michael D Wilson, LPCC
- Professional Counselor
- Columbia, KY
National Provider Identifier
1992893648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 651
- Practice address
- 200 E Frazier Ave
Columbia, KY 42728-1915 - Phone
- (270) 384-4710
- Fax
- (270) 384-4820
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- 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 | 651 | KY | Primary |
Addresses
Primary practice location
200 E Frazier Ave
Columbia, KY 42728-1915
Mailing address
259 Parkers Mill Rd
Somerset, KY 42501-3152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 651 | KY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One Cross Health Clinic Inc | Current | Accepting new patients | |
| One Cross Community, Inc. | Professional | Current | Accepting new patients |
| Teladoc Health Medical Group, P.a. | Professional | Current | Accepting new patients |
| Lake Cumberland Regional MHMR Board Outpatient | Past | Accepting new patients | |
| Lake Cumberland Regional Mental Health Mental Retardation Board, Inc. | Past | Accepting new patients |
Locations
102 Winston Way
Ste 5
Campbellsvlle, KY 42718
Phone (270) 789-0034
106 Winston Way
Campbellsvlle, KY 42718
Phone (270) 789-0034
429 W Walnut St
Lebanon, KY 40033
Phone (270) 295-1010
Interoperability endpoints
- michaelwilson@tdh.allscriptsdirect.net
Organizations & group practices 5
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.
-
- Federally Qualified Health Center (FQHC)
- Campbellsville, KY
- NPI 1447710314
Professional
-
- Rural Health Clinic/Center
- Campbellsville, KY
- NPI 1942606454
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Professional
-
- Community/Behavioral Health Agency
- Somerset, KY
- NPI 1336172642
-
- Community/Behavioral Health Agency
- Somerset, KY
- NPI 1992831713
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992893648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 PARKERS MILL RD",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425013152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E FRAZIER AVE",
"city": "COLUMBIA",
"state": "KY",
"postal_code": "427281915",
"telephone_number": "270-384-4710",
"fax_number": "270-384-4820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MICHAEL",
"middle_name": "D",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, KY
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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.