SHANE RAY WILSON LPC,LADC
NPI 1063742138
Counselor - Professional in Norman, OK

Q: What is Shane Wilson's NPI number?

The NPI number for Shane Wilson is 1063742138. It was assigned to this individual provider in the NPPES registry on January 12, 2010.

Q: What is Shane Wilson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Shane Wilson was last updated on December 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 12, 2010PECOS Enrolled

3750 W MAIN ST STE AA, NORMAN, OK 73072(405) 474-9374 Get Directions Write a Review

NPPES record last updated: December 21, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Shane Ray Wilson Lpc,ladc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE RAY WILSON LPC,LADC (NPI 1063742138) is an individual professional provider in Norman, Oklahoma, licensed in Oklahoma (2179) and active in the NPI registry since January 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063742138

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameSHANE RAY WILSONCredential: LPC,LADC

Location Address3750 W MAIN ST STE AANorman, OK 73072-4645

Mailing Address3750 W Main St Ste AaNorman, OK 73072-4645 · (405) 474-9374

Phone(405) 474-9374

Sole ProprietorNo

Enumeration DateJanuary 12, 2010

Last NPPES UpdateDecember 21, 2023

NPPES CertifiedDecember 21, 2023

✔ NPI 1063742138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in OK · 2179

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 135 (OK)

3750 W MAIN ST STE AA, Norman, OK 73072

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shane Ray Wilson Lpc,ladc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER LASSETER

Counselor (Professional)