| NPI | 1720198294 |
|---|---|
| Professional Name | J SHANE WILSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 103656) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0550) |
| 101YP2500X Counselor, Professional (Licence: TX 18552) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-03-01 |