Provider Demographics
NPI:1134015530
Name:WILSON, MERCEDES NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 E 45TH ST # C102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3805
Mailing Address - Country:US
Mailing Address - Phone:539-242-4100
Mailing Address - Fax:539-242-4111
Practice Address - Street 1:10830 E 45TH ST # C102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3805
Practice Address - Country:US
Practice Address - Phone:539-242-4100
Practice Address - Fax:539-242-4111
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional